Are you considering a career as a psychiatrist? With so many specialties to choose from and your future on the line, it’s one of the most challenging decisions medical students have to make.
This guide will cover the pros and cons of becoming a psychiatrist, from dealing with aggressive and delusional patients to the lack of concrete treatment options to the fantastic flexibility and work-life balance afforded to psychiatrists.
There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in training, whether or not you’ll perform procedures, the level of patient interaction you’ll have, your practice setting, the people you’ll work with, your work-life balance, how much you’re paid, and more.
This series takes a deep dive into the career of a psychiatrist from the perspective of Dr. Kevin Jubbal. He outlines the factors he considered and why he ultimately did not choose psychiatry as his specialty. That said, rest assured that this guide includes both sides of the story, outlining the pros and cons of pursuing psychiatry.
For a completely unbiased look at psychiatry, including more details into the daily life of a psychiatrist and the exact steps to take to become one, also check out our guide to How to Become a Psychiatrist (So You Want to Be…)
Psychiatry Pros — What I Liked
1 | Direct Impact on Patient
At the end of the day, most of us want to be happy and at peace. The beautiful thing about this specialty is that this is exactly what psychiatry aims to provide. As a psychiatrist, you get to work directly with people on improving their relationships, enhancing their self-awareness, and increasing their stability. Because of this, psychiatric care often leads to transformative changes in a patient’s life. Seeing patients progress from a low point in their lives to a state of wellness and happiness can be deeply rewarding.
While in many cases, this can take years, psychiatrists witness first-hand how treatment can restore hope and function, which provides a unique sense of purpose.
2 | Holistic Approach
Part of the appeal of psychiatry is psychological issues are multifaceted, complex problems that can’t easily be solved by simply prescribing a medication. It goes beyond the biological or pathophysiological processes of disease to look at social dimensions and psychological factors.
This approach can be particularly appealing if you enjoy analyzing complex problems. Addressing social support systems, personal history, and life stressors adds depth to the care provided and can help develop a deeper understanding of each patient.
3 | Intellectual Challenge
Unlike many medical fields with more concrete diagnostic tests, psychiatry requires nuanced, active listening and interpretation skills. Diagnosing mental health conditions often involves a great deal of detective work, where you must explore underlying patterns and test hypotheses.
If you enjoy continuous learning, psychiatry offers an evolving landscape with new theories, research, and therapeutic techniques.
4 | Flexibility and Variety
Psychiatry offers diverse work settings like private practice, hospitals, community health centers, telemedicine, and academia. This flexibility supports a better work-life balance and allows for deeply personalized career paths.
Psychiatrists may also choose to specialize in specific populations, such as adolescents, geriatric patients, or those suffering from addiction, as well as certain types of therapy, adding further diversity to the profession.
Learn more about the subspecialties of psychiatry with our guide: 7 Psychiatry Subspecialties Explained.
There are many different ways you can style your career path. You can do 8-5 M-F clinic, inpatient work, consults, or partial hospitalization/IOP programs for any (and all) patient populations.
Do you still want to do some more traditional medicine? You can work in a Med-Psych ward. Looking for more procedures? Transcranial magnetic stimulation (TMS) and electroconvulsive therapy are getting more and more popular now, and they’re developing more procedures and drugs yearly.
Would you prefer medical management of conditions, or does psychotherapy sound more appealing? Fortunately, both are options.
5 | Potential for Preventive Work
Early interventions in mental healthcare can have a significant impact on patients’ lives as they prevent conditions from worsening. Psychiatry allows for the potential to improve the wellbeing of patients before severe symptoms develop, which can be highly motivating for anyone who is interested in early-stage preventive care.
Plus, if you stick with talk therapy, there’s no risk of pharmacologic side effects.
6 | Attainable Residency
Psychiatry is and remains to be one of the most attainable specialties. It’s remained in the bottom four least competitive specialties for several years. Even in recent years, when people were talking about how it became significantly more competitive, it went from third-least competitive to fourth-least competitive.
The reason I like this is that when something is more attainable, the floor for how hard you must work to match is lower, but if you want to work your butt off, you can and then match into the top program in the country.
Keep in mind that competitiveness doesn’t mean how good or bad of a doctor you are, just how competitive it is to get into a specialty.
The Specialty Competitiveness Index we created uses official NRMP data and is an objective measurement, comparing all specialties against themselves. There are trends of most specialties having more publications, higher Step scores, and so on.
Psych’s Match rate went from 92 to 89, which is still very high. Dermatology, neurology, and plastics, the top three most competitive specialties, are hovering around 70 to give context.
7 | Excellent Lifestyle and Work-Life Balance
If you want, you can work as a psychiatrist from 9-5 with no call, no weekends, and no nights and still make over $300,000, which isn’t a bad gig by any stretch of the imagination. While this is technically lower than the average of all physicians for compensation, it’s not by much. And the lifestyle is definitely better than the average.
For context, neurosurgeons make the most money of any specialty at $763,908 a year, but they also have one of the most challenging lifestyles of any physician as, in addition to scheduled cases, they are required to take neurosurgery trauma call.
Psychiatrists can also choose to go into private practice, which has a much higher ceiling for compensation. Of course, this is true of many specialties, but with psych, it’s much more common.
Psychiatry Cons — What I Didn’t Like
1 | Ambiguity
Mental health conditions often don’t have clear-cut causes or easily measurable symptoms, and diagnostic criteria can be subjective. Unlike other medical fields with concrete tests and treatments, psychiatry frequently involves “gray areas,” where diagnoses evolve over time.
This ambiguity can lead to frustration, especially when treatments have varying degrees of effectiveness for different patients.
Oftentimes, you’re not solving the root of the issue in many patients but instead helping them deal with a chronic psychiatric condition. Plus, a great deal of psych research is more subjective than a specialty like cardiology, which has clear endpoints.
2 | Slower Pace
The slower pace of psychiatry can be boring for those who enjoy procedures or fast-paced specialties like pulmonology or emergency medicine. It can also be repetitive if you specialize in a specific mental health disorder, such as addiction, and patients present with many of the same issues time and time again.
Plus, not everyone is comfortable having deep conversations with strangers, which is who your patients are, at least at first. Each person is different, and it can be challenging to find a balance between spending too little time with patients and too much time with patients.
3 | Emotional Toll
Working closely with patients experiencing severe depression, trauma, or other mental health challenges day in and day out can lead to compassion fatigue. Maintaining a professional boundary while providing empathetic care is critical, but it can be draining over time, which increases the risk of burnout. Inpatient wards can be a particularly challenging environment to work in.
Psychiatrists need strong support networks and self-care strategies to maintain their own wellbeing.
4 | Combative and Aggressive Patients
And then there are the combative and aggressive patients you’re likely to encounter. For example, I did my psych rotation in medical school at a military base and dealt with an aggressive and delusional schizophrenic patient who would violently slam the table, froth at the mouth, and hurl racist slurs at me.
It was uncomfortable, to say the least.
Learning about the psychological underpinnings of human behavior is very different from treating delusional, violent patients who actively threaten you while you’re trying to help. It’s an unfortunate reality that psychiatrists are at the highest risk for physical harm from patients next to emergency medicine doctors.
Plus, patients may not be outwardly combative during a therapy session. Instead, an unhappy and disgruntled patient could wait for you after work or follow you home.
5 | Mid-level Scope Creep
While this is more of an issue in primary care, it’s also a significant issue in psychiatry.
The term “mid-level” refers to nurse practitioners, physician assistants, and advanced practice providers—all of whom are vital to patient care.
However, the shortage of physicians in the US combined with hospitals trying to save as much money as possible means mid-levels are being tasked with some of the responsibilities of a licensed doctor.
While much less common in surgical specialties, which require more specialized, technical training, more and more mid-levels are being asked to perform the duties of a psychiatrist or are taking on those duties themselves. This can have a severely negative impact on patients who require the kind of specialized care provided by licensed physicians who have undergone specific psychiatric training.
Now, that’s not to say I’m anti-midlevel. However, I am anti those who succumb to the Dunning-Kruger effect in full force and put others at risk as a result. For example, mid-levels who argue they’re just as competent and well-trained as physicians.
I speak about the impact and research behind Midlevel Encroachment in a previous guide.
6 | Stigma Around Mental Health
Both patients and practitioners in psychiatry may face societal stigma.
Despite advances in mental health awareness, there are still lingering biases against psychiatry within the medical community, which may impact professional satisfaction. This stigma can also affect patient outcomes, as some individuals avoid seeking care due to societal perceptions.
For example, there’s an entire religion against the field in Scientology. Looking at you, Tom Cruise.
7 | Limited Biological Understanding
Psychiatry is still uncovering the biological basis of many mental health conditions.
Unlike other medical fields where pathology and treatment protocols are more established, psychiatric treatments sometimes rely on imperfect science, and there are a great deal of treatment failures. What works for one patient may not work for another patient who presents the same psychiatric disorder.
This may be frustrating for those who are science-driven, as much of psychiatry still relies on clinical experience and trial and error.
8 | Medical Knowledge Usage
While you spend so much time and effort learning about the human body in medical school, only a small portion of that knowledge is utilized in psychiatry.
Many of the therapies in psychiatry are talk therapy-driven or pharmacologic from the perspective of throwing a bunch of drugs at a wall and seeing what sticks. Once again, a great deal of psychiatry is trial and error.
9 | Medication Side Effects and Dependency Issues
Psychotropic medications can be life-changing, but they come with side effects that may impact a patient’s quality of life, such as weight gain, tremors, headaches, diarrhea, constipation, sleep changes, mood swings, sexual dysfunction, and increased risk of suicidal thoughts.
Additionally, managing medication dependency or misuse can add challenges, particularly when patients develop a reliance on certain prescriptions. This can create ethical dilemmas and frustration over limited options.
10 | Patient Compliance and Engagement
Unlike treatments in other fields, psychiatric care often requires a significant commitment from patients, such as lifestyle changes, regular appointments, taking their medication consistently, and therapy sessions. When patients do not engage or commit to their prescribed therapies, treatment outcomes suffer.
This can be incredibly disheartening for providers who feel they’re unable to help as fully as they’d like. After all, psychiatrists, as well as any physician in a patient-facing specialty, can only do so much. Much of the responsibility falls on the patient to follow your recommendations, and if they don’t, there’s simply not much you can do.
11 | Insurance and Resource Constraints
Insurance often limits the types of treatments and frequency of visits, impacting patient care and psychiatrist autonomy.
In many regions, there is a shortage of mental health resources, resulting in overburdened schedules, waitlists, and insufficient time spent with each patient, which can negatively impact both patient outcomes and job satisfaction.
Is Psychiatry the Right Career for You?
So, is psychiatry right for you?
It all depends on the aspects of medicine you’re most passionate about.
There are downsides to every specialty, and choosing the right one for you is about pairing the type of challenges you’re prepared to face in your day-to-day with whatever makes you excited to get out of bed and go to work.
What specialty has a downside you can tolerate and an upside that you adore?
Unfortunately, psychiatry does have a number of downsides:
- Psychiatry isn’t necessarily a perfect science, and you can often only help your patients through clinical experience and trial and error.
- Psychiatrists are at the highest risk for physical harm from patients.
- It’s an emotionally taxing specialty in which you spend most of your day listening to sad stories from deeply troubled individuals.
- Patients won’t always comply or engage with their treatment.
- It’s a slower-paced specialty with few or no procedures that typically involves a great deal of talking, active listening, and patient interaction.
- There are insurance and resource constraints that mean you can’t always provide the kind of treatment you believe your patients need.
However, psychiatry is an excellent choice for those with a passion for mental health, resilience and patience in the face of ambiguity, and an empathetic yet boundary-conscious approach to patient care.
As a final note, something so many people fail to consider is how much your own mental health and wellbeing directly impact your ability to provide quality care for others. This is why it’s so essential to choose a specialty that aligns with your strengths and interests. If you are easily bored, frustrated by ambiguity, and don’t like the sound of speaking with relative strangers all day, psych likely is not for you.
At the end of the day, only you can decide if the pros outweigh the cons. Put in the time to figure out what career path is the right fit for you. We have multiple series here on the Med School Insiders website as well as on our YouTube channel that dig into the ins and outs of what each career path is like.
If you want to learn more about psychiatry, check out So You Want to Be a Psychiatrist.
