Psychiatrist Interview | Day in the Life, Psychiatry Residency Match, Vs Psychologist, Career, etc.

hi everyone today I'm here with dr. Pia a community child and adolescent psychiatrist as well as a club clerkship director at our medical school so before we start I wanna say thank you dr. Pierre for agreeing to this interview and so real quick before we dive into more of the details could you give us an explanation of what psychiatry involves sometimes people have confusion between psychology and psychiatry so could you give us a brief overview of that to go into the field of psychiatry the difference between psychiatry and psychology is you have to go through Medical School which is four years of medical school and after that you then decide whether you want to be adult psychiatrist or a child psychiatrist or going to another kind of psychiatry so you then have if you want to be an adult psychiatrist you have another four years if you want to be a child psychiatrist up that you do three years and then another to enchance the country and then you can do forensics or substance abuse or specialize in other kinds so if you're looking at a lot of school for that versus in psychology you go through the psychology trade training program so you want a physician you are not allowed to prescribe medications although some states are allowing some psychologists to provide medications okay and so you mentioned a few of those specialties in psychology or psychiatry so what what are like the big sub specialties in psychiatry the major ones are adult psychiatry there's child psychiatry there's geriatric psychiatry the substance abuse this forensic trained psychiatrist those are the people you see in the courts who are being asked to provide testimony those are the major ones you mentioned you went into medical school later what made you decide on medicine and psychiatry in particular okay so the most important thing that you should know is that I decided I would do anything about psychiatry I didn't like psychiatry I didn't enjoy it in medical school and so I said anything but psychiatry but then I decided I was going to Pediatrics but during my PDI Drix rotation there was one day when I came back thinking yes it's Pediatrics and that was the day when I interviewed a girl who was suicidal she was 13 and I just knew that day that it wasn't that I was interested in pediatric such as the psychiatry part of it and from then on I went into it I loved that psychiatry unlike all the other different specialties there's nothing that's black or white about it once you know what the lesion is is neurology so I like that it's always working in the gray with the final black box so I really have found it fun it's a fun if you like working like what personality types kind of do well in psychiatry I think just about all the secod all the different personality types except people who don't want to engage or quiet and withdrawn anyone who can interview and I think all of us in medicine will want to interview and ask people questions I think the most important ingredient is that you have an insatiable curiosity about others because that will help you ask the questions that are pertinent it will help you also to have the skills so you can engage people in a comfortable way so they can tell you their deepest darkest secrets it's a huge privilege because many of these people are unwilling to tell anyone even their closest family members horrible things that have happened to them or that they're thinking so it's a huge privilege that they will if you if they have your confidence you can keep this knowledge to yourself and what's the typical day in the life like as a psychiatrist from when you come into when you leave and it's going to differ so whoever you are so it's going to be different so I am mostly a community child psychiatrist which means I have only an outpatient practice and I work at the medical school so if you're asking me I guess you asking me about what my day would be at mine clinic and my clinic right so usually the county will allow me up to an hour to see my patients and to write up their notes and because I work at the very high intensity clinic usually in the meeting you'll have the kid the mother myself and usually a therapist or facilitator who's managing these patients so what happens is you see the patient sometimes I have two hours to do an initial intake but then after that you're seeing patient doctor patient every hour writing and notes then you're meeting separately with the clinicians to discuss hey you know do you think some parent-child therapy would work or shall we recommend that the kid has anger management so we have interactions not only with the family I always see the kid alone so that takes time I then talk with other doctors I don't with other people in the team and we come up with a sort of a comprehensive team approach treating these kids if it's most medication patients then I go ahead and see them once a month but some kids like I have a key person who's quite severe anxiety I would see her every week if necessary because the anxiety is so severe and it's really medication management mostly but you often just have some kind of therapy you know helping patients to deal with stresses within this session also and then I take them you know a break at lunch when I I usually just do lots of my note writing then - and then my day finishes my last patient is at 3 o'clock but I'm usually there till about 6:00 because I'm writing the notes and the calls and the emails and all the other things that are socratis does do you have more time with patients as opposed to a lot of others versus ease whether it's like 10:30 minute yes thanks and that's one of the things I love about this I told you it's a it's a gray area right working out what's what's going on for someone so we don't have the luxury of saying okay let's just order a sodium and potassium and all of those things so we they the psychiatric history and examination is our labs is our imaging is on everything because if you don't do a good job of that you're not going to know what's going on so in other specialties you could just say oh let's get an x-ray film well let's look at the you know the skin findings or whatever you're doing but in psychiatry your ability to interview and elicit this information is going to take a lot more time so I'm very fortunate to have chosen to work in the community I have up to 45 minutes to spend on doing these good assessments when I see them every month or seeing them in two weeks if I need to but of course if you do a different kind of sobriety like in the hospital you probably wouldn't get that kind of time because you'd be having quick follow-up meetings so it's a different kind of psychiatry they would do better so how is the lifestyle of the physician different in psychiatry as opposed to other specialties that really depends on what kind of psychiatry going to and so for me unfortunate that because it's paying very well because there's a huge shortage of child psychiatrists and that's what the audience should know we have I think only about less than 10,000 and we need more than double that and so there's a huge need so most psychiatrists that I know that are child psychiatrists are able to have different things they can work the three days doing let's say clinical work and then do some teaching like I'm doing so because of that you can actually carve your your day out the way you want to come your week out the way you want so most of us choose to do a few different activities and and the and so I can have a lot of free time so I could actually probably make ends meet with working three days and most of my colleagues are the same so there's a lot of flexibility and even now even though I've been so many years out of training there's so many people are asking me would you come here would you come there we'll give you a sign-on bonus so it's nice to be really wanted commodity because people are looking for this that they want you so you can pick what you want to do so you can do a little bit of Hospital work if you want and a little bit of so you can make your day work the way you want it I don't take call because I don't look in the hospital so I don't have to I have my weekends to myself and so trying to find every time okay and so one question I wanted to ask was how you're able to like do academic work or pursue other things like research if you wanted and things like that but it seems like part of that's like maybe an innate part of psychiatry where you have more flexibility and leeway with your scheduling is that true yeah we have a lot of leeway in all scheduling so if I wanted to do some reason absolutely I could just say hey two days a week I'm going to work in research so it's just a matter of what you want to do you can pick and choose do you want to be primarily in a in a setting where you're doing research in an academic setting or do you want to work with the psycho farmer you know with the drug company or do you want to be a community psychiatry so I have chosen to do what I do so really you have the choice it's not like you have to be state so if you love to do research you're probably going to go into an academic institution and do research there's no problem doing that and you mentioned child psychiatrist being in demand our other psychiatrists in demand too or is it mostly just child psychiatry psychiatry isn't demanded I believe in 2017 the it's a second in the country only two family physicians so they need family physicians number one like the live psychiatrist came in to I don't know if it's changed in 2018 what's the most challenging aspect of psychiatry that's a great question I would say it's probably different for different people but for me it it took most of residency for me to learn to walk the tightrope of not caring too much in which case you just cannot do your job you go home and you're thinking about it all the time but if you care too little and you just say up next person is suicidal next person song title you aren't being a good psychiatrist so to me the hardest job for me is learning to walk the tightrope of caring enough so people know that you really care about them but not caring too much or too little I'm learning that balance is fine-tuning because you learn open over residency those four years of adult residence you learn how to manage those feelings and how to compartmentalize it and not bring the work that you see you know the horrible stories back into your house deform that boundary takes a lot of time I feel like that's personally difficult for me excited I usually make it emphasize too much or it's like paralyzing sometimes or often and that just makes me anxious all the time because I'm afraid of going to those situations again where you know I'll get more of that and that's why I think that most of residency is less about learning the psych psychotropic drugs and more managing those emotions and so in many residency situations like I had in San Mateo you have this ability that you have a patient and you have a supervisor for that patients of everything you say is assessed hey you know did you notice you asked this question and so you're really taught how you're responding to these people and so it's wonderful to learn how to do it so it's good that you're feeling an anxious now because of course you should be and that's why the residency takes that long to learn how to manage those feelings okay and what's the most rewarding aspect of psychiatry there's the immediate rewards when people suddenly just divulge things that they have not told anyone even their own mother or their own father that is rewarding because it's never one approach you try something at someone they have to try something different so I love that immediacy of that feeling and also I love working with my team because we all sort of try and figure out how to help the patient not just with medicine but with therapy or with other kinds of different interventions like getting a parent advocate or something like that so I love that Memphis the long-term results so you might think I've been telling this person you know quit the drugs quit the drugs and if you stick with them sometimes years later you find they did so there's that long-term Wow they got so much better so I love it I mean it's always challenging because there's never a one-size-fits-all it's not like I look in your ear oh it's effective it's never that simple so I love that you're always trying to solve problems like a detective that's fun what are some if there are any I'm sure there are misconceptions about psychiatry one of the biggest misconceptions is that you know in the movies number one the psychiatrist is always a bad guy oh that's a big they always make us out to be these people who just want to put medicines on everyone and they just lump us into that either we're all the medicating doctors or they make us think they make the public think that you're just going to be lying on a couch and I want to see tell me about your mother and and the truth is is not either of those if you want to do a psychotherapy then you have that sort of Freudian way sitting on a bench you're talking but typically we really do intensely care about our patients and so I think the movies doing disservice to us by making us feel like we want to medicate many a time a patient will come in to me I'll do my to our assessment I'll say I don't want you to be on medicine and so I really do not push medicines in fact I'm always trying to push people from medication to going ahead and doing therapy alone which is people don't realize sometimes that's what we try to do we try to the opposite not just throw medicine to fix things and for that point do you refer them to a clinical psychologist to do the more of the therapy or do you do that yourself I work with a lot of social workers and MFT interns and marriage and family therapists so we do it together I usually are able to come to my assessments all say hey you know can you do the cognitive behavioral work on when you see them on Thursday and I'll do the medicine and so we do integrate our work so yeah okay so it's a interdisciplinary couple it is it's fun I'm teachers I forgot to mention we get teachers these have to sometimes talk to probation officers sometimes legal people the courts I've had to testify in court so it's kind of a lot of different things one does that's kind of fun how would you recommend getting into psychiatry matching to good residency and fellowship if you're trying to pursue that I I would say that it is still even though it's really wanted it's still very competitive I remember in one of the residency programs I think they said there I the 400 or 500 ocular applicants for four spots so the first thing you'd want to do is really figure out if you want to do sakauchi by in your third and fourth year if you love it in third year going into your fourth year going ahead and trying to ask if you can do another exposure let's say you did only inpatient doing some outpatient I recommend going to meetings because I think some people think all these shrinks are weirdos I used to think that myself so and when you actually meet people and you realize hey they're just like you and me you know they get paid well they love their jobs so going into meetings going into other chances once you know for sure this is you and you are okay with being on that gray level of not really knowing and being good at investigating then I would say spread your night white even though there's a lot of demand you want to go ahead and know that the very that the programs were the highest number of student applicants are going to it's going to be harder to get it to them mostly spread your net wide and and go for it would you not recommend things like research or like extracurricular activities as much I would say that if you were going to a program which was you know one of the Ivy League's or one of those where they really are looking at research of course it's going to be a help but there are many there all the programs that people are applied to they need to figure out are they primarily community based like the one I went to are they more academic and there's a big difference you know it's a big difference between how the programs are set up whether it's academically based or community and also one of the things that I really enjoyed in my training was psychotherapy and that sometimes in some of the more academic rigorous programs they sometimes don't spend as much time teaching in the elements of Freudian psychotherapy so I'm grateful I got that training also so there's many different things to look at when in deciding what programs to apply to you mentioned practice settings being kind of variable with psychiatry so it seems like there's a lot of opportunities to do like big groups and also like private practice would you say there's because like a lot of specially there's like a shift to moving away from private practice to like bigger groups do you think psychiatry is pretty strong on private practice still and there's a lot of opportunities with that already maybe like local and tenon's work or something right and that's going to say again that's why it's so beautiful because because they need us so much specialty you can choose like I have had my own private practice for many years before I decided to do mostly a community so you can choose with your personality style are you okay sitting in a room just talking one-on-one and having very little interaction with other people is that what you like or do you need that sort of academic stuff going on or do you need that feel of community where I told you I work with so many different people so you have to figure out what your personality style is like and then sometimes many psychiatrists will try a bit of all of them and find a way to to sort of rest some people very rarely choose just primary care I mean private practice most will do a little bit of something and something else but some can go into therapy which is no medication we just see a patient's and just build up a practice that way so I would say that it's rather than feeling limited by what's out there it's more what you want and you decide what your temperament is like and then you choose your practice setting and so we don't really get business training in medical school what tips would you recommend or like what would you recommend do any tips first on starting our own business or managing your own business well if we do end up doing then private practice work and I was fullest myself because it wasn't don't you're right we don't need to teach that in medical school very well but I would suggest you get a mentor you get someone that you identify before you've even graduated from your residency program and during residency you want to see people you kind of really admire get them to talk to you about what it's like setting up their private practice so I went to a mentor and I said could you show me your forms and could you show me how you do it it's amazing how quickly you can learn when you just start given the forms and basically set up the office yeah but there is a lot to it so it's a letting go yeah I guess if they're just to jump in and you do anything yeah you said that conversation is pretty good relative to what you're doing the our input and the energy input versus like the financial output how would you recommend kind of maximizing that compensation for those that want to try to do so so so clearly it's also how many days you choose to work so if you just say I just want to make a huge amount of money then obviously you will be working at least five days a week and usually reimbursements at hospitals is much higher so you would work in a hospital for a certain number of days and so you would decide if that would be the way you do it versus you know just for most of them asking about salaries you can make about sometimes as a child psychiatrist about close to two hundred three hundred thousand dollars for working a few days a week so you don't even have to work all over a week to get that kind of money so it really just depends on what you're willing to give up in order to do the work what psychiatry like a lot of specialties you do specialize in something but there's still like overlap with other areas of Medicine it seems like a lot of psychiatry is less physiology do you feel like you're missing out on that aspect or are you fine with kind of the area of expertise you're in okay and that's that's a great a good question I was going to say that I was the the thing I really fought the hardest was hanging up my white coat and thinking oh no I learned all of this stuff and what am I going to do and the truth is that especially because I work with children and because I have time in psychiatry I am drawing pictures and doing physiology every single day with almost every patient I'm drawing pictures about what happens to the you know the adrenaline what happens to the stomach when you've got GERD and you're anxious and drawing pictures of it so so I'm teaching and to teach you have to show when these medicines go here and here's the liver so it's kind of fun because you're using your medical knowledge and in order for you to be a good psychiatrist you have to know for sure that the presentation is not medical right because if it's medical you shouldn't be doing psychiatry so in order for the diagnosis to my psychiatric you have to rule out medicine so you constantly wondering gee is this really anxiety or could it be hypothyroid could it be so you definitely utilize your information it's just in a different way I'd say mostly for psychoeducation but also for ruling something out thinking gee why did this person get referred to me this is a delirium it's not psychosis like that so you use it a lot could be a misconception I think okay so since the feel of medicine is always changing so quickly especially nowadays of more and more research coming out every day how do you recommend staying on top of the advances on in medicine and how do you do it personally so the best way to do it is to be forced to do it by trying to retain your both certification so you have to do a certain number of continuing medication and continuing medical education credits CMI's so they you have to do a certain number for it just to be licensed and you have to do so many for both certification and when you're doing that you have peer review you have journal articles and that's how I do it I work with a team of doctors so sometimes we look at each other's charts I do that by teaching was I have to refresh my knowledge and I get journals you know the American Academy so that the journals from the Academy and they're moving to something called a maintenance of certification next year where you just are given all these journals and you have to answer questions so they're trying really hard to keep us on our toes with certification if you aren't planning to be both certified then the other way is by attending meetings they're great by talking to your fellows by allowing fear involvement hey why'd you treat that person with such-and-such so there's many ways to do that and so you mentioned if you wanted to be board-certified you could do those things do a lot of psychiatrist practice without board certification okay don't know I mean in some places you're required to be both certified like for example in the forensic setting when you're going to be going that usually people will get both certified in forensics but not necessarily so it really is your decision but in academic settings I think there's a preference that people get all certified interesting I thought everyone just had to automatically get board certified to practice yeah is that it's a choice is that just for psychiatry for everything I think it's for everything you don't have to I don't think really I don't know this depends what you want to do that's interesting you can often ask for more money if you say well I'm a board-certified but most people will need you to be at least board eligible meaning that you've done all the requirements and you're illegitimate to be certified but you may not have actually gone through the certification okay so kind of on that topic of trying to keep up with all the advances and things like that I guess you mentioned psych I should be a little bit more conducive to this but how do you recommend preventing burnout that's a good question and I think that the most important thing is to do what I told you it was important for me which is learning in those four years of residency how to keep your life that is personal apart from your work life it's forming that boundary because if you do that then you will give the people who you care about will see the signs of burnout in you and you're still listening right so my recommendation is to not just go into it and just try to make a lot of money but to realize it's work and to carve out time for your your free time and to take the time if you have to and also to ask people you know or to my biggest recommendation is to take it slow - just say cut down your hours you can still make a good living you don't honestly have to work five days a week and the one time I remember that I actually broke that rule for myself I had to testify and I took the records home which I never do I leave my work at home I never take anything I'm rarely consulted after house but that night when I broke my own boundary I remember just having a nightmare of my patients and I'm thinking about them which never happens because I'm pretty good about my boundaries so it shows that when you break your own boundaries those memories and thoughts can intervene in your other life so it's a good question again with the like there flexibility of psychiatry and leaving kind of mentally the work that you did in clinic behind this kinda plays in part into this question but how do you have any more tips on establishing work-life balance pretty much more than I already said I'd say do not take you can decide we don't call whether you're going to allow a job where you're going to have to have call that's a decision you make and also whether you take jobs home I strongly recommend not to that really it's just you know to exercising looking out for your foot and asking your friends frequently it's do I look okay to you do I look stressed all the time pretty much those are the biggest things I can't think of anything else pacifically how is medicine changed since you started practicing and where do you see it going in the future I think one of the things that concerns me the most is the fact that we are becoming much more mechanized which is good and bad right because I can now treat people's notes when I get a patient instead of seeing a scribbled note but the problem with the computer is the fact that I'm losing this direct interaction with you if just now you were talking to me and I was just busy typing I'm distracted and I'm not really we're losing that human touch and we're trying to make sure that everything is documented so what someone Sue's you it's all there and I think that's true of just about anything in medicine but especially in psychiatry I think it's critical to not use the computer in the interaction to do the notes after not to try to them so that worries me a lot but on the other hand it means and also it means a lot more busy time so you're busy just you've seen the patient you know what's going on you're just going to do this but you have to spend like almost as much time as you saw with the patient to doing it all and dealing with county forms and this so it just becomes a little bit like it causes burn out sometimes but that's true of not just psychiatry it's true here the ones - do you see a way to resolve that issue but again you can choose you can choose where you're going to go are you going to go into a facility where people are incarcerated and you know you can decide what suits you and another thing is you know let's say someone who's watching this is thinking about maybe psychiatry I so strongly recommend you follow a doctor like for a day for example someone was very interested in psychiatry came watch me for just I wasn't even a bad day and slept for 12 hours after that and said never in my life so it's really important to just check out what you can and come on I know that's not quite your question but anyway if you could go back would you change your career path or is anything about you changed absolutely not I love what I do I really love it it's so cool to feel that you have a chance and because you unlike the other kinds of medicine you're changing people's behavior and what they're doing and so the way I look at it you're changing these people's behavior and the thousands of people who may interact with this person so you're not just changing that one person in changing thousands so it feels really cool to feel you had a little hand and helping guide that and people get a lot better you know even if they go this is incapacitating anxiety you see people getting treated so it's just a wonderful feeling of I managed to help with this there's always the side things like you know with anything like when you've got drug abuse like in telemedicine you've got those people like the people have schizophrenia and don't often make a huge improvement or people who keep using drugs but that happens in all kinds of medicine so there's some way you will not make such an impact but there's a lot way to make a huge impact so okay and one question I forgot to ask was what are the most typical cases that you see usually because I work primarily with children I'm both certified in both but I work with children so I see mostly a lot of ADHD I'd say a huge amount of post-traumatic stress disorder because my children come from really traumatized families hostage Kate's kids have been abused depression anxiety is always in there very rarely you see psychosis that is from schizophrenia and children it's very rare so I don't see that as much I don't see as much bipolar disorder I see some things like autism and some of the developmental disorders learning disorders things like that mostly we talk about burnout a little bit anxiety and depression are like big things even it's in like medical school what tips would you recommend for us to manage those better well I'm really excited that this medical school is going to start up a program where you have sort of peer guidance for people who are feeling depressed so I'm just excited that you will feel there's less stigma one of the biggest problems that helplessness stigma I want to get help I mean if you had a cancer that was spreading and it was stage 3 the whole world would know about it if you're almost ready to kill yourself because you're suicidal nobody sometimes knows about it so removing that stigma by having an open communication among your peers knowing when to go and see a psychologist which should be available and when that person might prefer a psychiatrist so yeah so it's actually important to have a communication between the psychologist between the other peers and then know when to refer to a psychiatrist and obviously I think your school has is all these yoga making sure that people are gettting sort of like wellness wednesdays ways that you can just keep your mind focused on it's not as important to rush through this if it's not working for me to take some time off like I did I took extra time of a med school because I wanted it to not be stressful when I had a family to look after I was a single parent of two kids so yeah I think it's very important to listen to others and to try and communicate so you took off time to take care of your kids in the middle of medical school I took six years to do med school I wasn't even sure I'd make it through quite frankly it was so stressful because I had to go home and you look after the kids so it meant that I was getting further behind and so I was not studying like I should but I just found out that UC Davis allowed me to spread out my training and it was the best decision I ever made because I think there's a lot of pressure in medical school when you think that you just have to everyone surround you and you have to compete and just feeling you've got to run the game and do it with everyone else because you started them it's like being burned in fire because you come together and sometimes it just seems so hard to imagine that you should let that go but I sometimes think that is the absolute right decision for yourself is it and it's sometimes the right decision for your family so more than once I have talked to people to take time off be with your family because really you will be a doctor you made it through all the hoops right so I think it's critical that people realize they have that did not feel like a failure just because they're dealing with some kind of family issue internal stuff I guess it's part of like that innate human tendency to compare yourself to like your local you know peers yeah yeah it's a good one to stop and think what do I want for my life right that's a good point so last question what to siddig us have become good doctors say number one realized that we are a servant of men we are there to help people and to keep that empathy going through all the oh boy I'm so tired I'm exhausted to see each person as a fresh new person and the best way I can think of is to think that could be my father that could be my sister to keep reminding yourself and it's hard because we have pushed we have you know we work our tails off and the center you're thinking oh God you know you don't want to but to try and keep that freshness about you that makes you think here's a brand new person this could be my mom to keep that connection everything else you know med school they teach us the tools they teach us the knowledge but the actual warmth and empathy that really can help more people than just throwing the right medicine at them and this evidence that shows that it's just that engagement that does a lot of the healing no matter what you're in whether it's a country or something else that is keeping that warmth and that enquiring mind going when you're tired and exhausted that's the most important thing okay thank you for the time you spent with us I think you guys for watching let me know down below in comment section if you have any questions for dr. Pia and I could maybe ask her them let me know I'll also Dumble a description or the comment section who we'd like to interview next I think you can dr. P for being for this interview and because how great is your day [Music]

Channel: Adnan A

Views: 68,432

Keywords: medical school, medicine, medical, school, college, undergrad, residency, match, matching, a day in the life, day in the life, doctor, med, med student, student, physician, surgeon, nurse, pa, dentist, pharmacy, interview, md, do, osteopathic, allopathic, intern, internship, good, specialty, panel, premed, prehealth, health, fitness, nursing, hospital, clinic, vlog, debate, pmr, anesthesiologist, pain, physical therapist, orthopedic surgeon, surgery, trainer, professor, phd, or, psychiatrist, psychiatry, psychologist, psychology

Id: SFViaLm_YoA

Length: 33min 59sec (2039 seconds)

Published: Sat Dec 22 2018