Psychiatrists are physicians who attend to patients’ mental, emotional, and behavioral symptoms. They try to help people function better in their daily lives. Physiatrists generally specialize by treatment methods, based on their chosen fields. They may explore a patient’s beliefs and history. They may prescribe medicine, including tranquilizers, antipsychotics, and antidepressants. If they specialize in treating children, they may use play therapy. There are over 30,000 psychiatrists working in the United States.
Psychiatrist Career History
The greatest advances in psychiatric treatment came in the latter part of the 19th century. Emil Kraepelin, a German psychiatrist, made an important contribution when he developed a classification system for mental illnesses that is still used for diagnosis. Sigmund Freud, the famous Viennese psychiatrist, developed techniques for analyzing human behavior that have strongly influenced the practice of modern psychiatry. Freud first lectured in the United States in 1909. Swiss psychiatrist Carl Jung, a former associate of Freud’s, revolutionized the field with his theory of a collective unconscious.
Another great change in treatment began in the 1950s with the development of medication that could be used in treating psychiatric problems, such as depression and anxiety.
The Job of Psychiatrists
Psychiatrists are medical doctors (M.D.’s) who treat people suffering from mental and emotional illnesses that make it hard for them to cope with everyday living or to behave in socially acceptable ways. Psychiatrists treat problems ranging from being irritable and feeling frustrated to losing touch with reality. Some people, in addition to having a mental illness, may also engage in destructive behavior such as abusing alcohol or drugs or committing crimes. Others may have physical symptoms that spring from mental or emotional disorders. People with mental illness were once so misunderstood and stigmatized by society that they were kept, chained and shackled, in asylums. Today society recognizes that emotional or mental illnesses need to be diagnosed and treated just like any other medical problem.
Some psychiatrists run general practices, treating patients with a variety of mental disorders. Others may specialize in working with certain types of therapy or kinds of patients, such as the chronically ill. When meeting a client for the first time, psychiatrists conduct an evaluation of the client. This involves talking with the person about his or her current circumstances and getting a medical history. In some cases, the psychiatrist will give the client a physical examination or order laboratory tests if he or she feels the client’s problem may have a physical cause. Next, the psychiatrist decides on a treatment plan for the client. This may involve medications, psychotherapy, or a combination of these approaches.
As medical doctors, psychiatrists can prescribe medications that affect a client’s mood or behavior, such as tranquilizers or antidepressants. Scientific advancements in both the understanding of how the human brain functions and the creation of more effective drugs with fewer side effects have helped make medications an important element in the treatment of mental illness. Some psychiatrists will only supervise the medication aspect of a client’s treatment and refer the client to another health professional, such as a psychologist, for the psychotherapy aspect of treatment. These psychiatrists often work in private practices and focus on the chemical aspects of a person’s illness to find medication to help that client. Other psychiatrists, often those working in hospitals or in small cities and towns, may be the providers of both medication management and psychotherapy.
Psychotherapy, sometimes called talk therapy, is perhaps the best-known type of treatment for mental illness. By having the client talk about problems he or she faces, the therapist helps the client uncover and understand the feelings and ideas that form the root of his or her problems and, thus, overcome emotional pain. Talk therapy can be used with individuals, groups, couples, or families.
Another therapeutic method used by some psychiatrists is behavior therapy or behavior modification therapy. This therapy focuses on changing a client’s behavior and may involve teaching the client to use meditation and relaxation techniques as well as other treatment methods, such as biofeedback, a process in which electronic monitors are used to measure the effects that thoughts and feelings have on bodily functions like muscle tension, heart rate, or brain waves. This method allows the client to learn how to consciously control his or her body through stress reduction.
Free association is a technique in which the client is encouraged to relax and talk freely. The therapist’s aim is to help the client uncover troubling subconscious beliefs or conflicts and their causes. Dreams may also be examined for hints about the subconscious mind. Subconscious conflicts are believed to cause neurosis, an emotional disorder in which the patient commonly exhibits anxious behavior.
In addition to seeing clients, psychiatrists may also work with other health care professionals in the course of treating clients. Dr. Jenny Kane, who is in charge of a psychiatric ward of a hospital, notes that meetings are an important part of her work. “At least three to four times a week, we have treatment planning meetings. These meetings are multidisciplinary, so anyone who is involved with treating the patient is in attendance.”
In addition to those working in general psychiatry, there are psychiatrists who specialize in working with certain groups or in certain areas. These specialists include the following:
- Child psychiatrists work with youth and usually their parents as well.
- At the opposite end of the age scale are geriatric psychiatrists, who specialize in working with older individuals.
- Industrial psychiatrists are employed by companies to deal with problems that affect employee performance, such as alcoholism or absenteeism.
- Forensic psychiatrists work in the field of law. They evaluate defendants and testify on their mental states. They may help determine whether or not defendants understand the charges against them and if they can contribute to their own defense.
No matter what their specialty, however, psychiatrists must deal compassionately with clients. Kane says, “You must be able to empathize with them, you must have a desire to help them. If that is lacking, I would imagine that you’d be constantly frustrated in your patient dealings.” In her position at the hospital, Kane sometimes sees people who come in with frostbite, infections, or other medical complications because they haven’t been able to care for themselves physically. In these circumstances, a psychiatrist’s medical training in dealing with the body comes into play. “I treat anything that a family practitioner would treat,” Kane explains. “If it’s necessary, I call in a specialist.”
Other health professionals who may work with mentally ill people include psychologists, who may see clients but are unable to prescribe medications because they are not physicians, and neurologists, physicians specializing in problems of the nervous system. In some cases, a person’s disturbed behavior results from disorders of the nervous system, and neurologists diagnose and treat these conditions.
Psychiatrist Career Requirements
If working as a psychiatrist sounds interesting to you, you should start preparing yourself for college and medical school while you are still in high school. Do this by taking a college preparatory curriculum and concentrating on math and science classes. Biology, chemistry, and physics as well as algebra, geometry, and calculus will all be helpful. You can also start learning about human behavior by taking psychology, sociology, and history classes. In addition, take English classes to develop your communication skills—much of this work involves speaking, listening, and record keeping.
When you are deciding what college to attend, keep in mind that you’ll want one with a strong science department, excellent laboratory facilities, and a strong humanities department. You may want to check Medical School Admissions Requirements, a publication by the Association of American Medical Colleges (AAMC) to see what specific college classes you should take in preparation for medical school. Some colleges or universities offer a “premed” major; other possible majors include chemistry and biology. No matter what your major, though, you can count on taking biology, chemistry, organic chemistry, physics, and psychology classes. Medical schools look for well-rounded individuals, however, so be sure to take other classes in the humanities and social sciences. The AAMC reports that most people apply to medical school after their junior year of college. Most medical schools require the Medical College Admission Test as part of their application, so you should take this test your junior or even sophomore year.
In medical school, students must complete a four-year program of medical studies and supervised clinical work leading to their M.D. degrees. Students will once again concentrate on studying the sciences during their first two years; in addition, they will learn about taking a person’s medical history and how to do an examination. The next two years are devoted to clinical work, which is when students first begin to see patients under supervision.
After receiving an M.D., physicians who plan to specialize in psychiatry must complete a residency. In the first year, they work in several specialties, such as internal medicine and pediatrics. Then they work for three years in a psychiatric hospital or a general hospital’s psychiatric ward. Here they learn how to diagnose and treat various mental and emotional disorders or illnesses. Some psychiatrists continue their education beyond this four-year residency. To become a child psychiatrist, for example, a doctor must train for at least three years in general residency and two years in child psychiatry residency. Part of psychiatrists’ training involves undergoing therapy themselves.
Certification or Licensing
All physicians must be licensed in order to practice medicine. After completing the M.D., graduates must pass a licensing test given by the board of medical examiners for the state in which they want to work. Following their residency, psychiatrists must take and pass a certifying exam given by the American Board of Psychiatry and Neurology. They then receive the designation of diplomates in psychiatry.
To complete the required studies and training, students need outstanding mental ability and perseverance. Psychiatrists must be emotionally stable so they can deal with their patients objectively. “Working with emotional disturbances on a daily basis can be draining and exhausting—even discouraging,” notes Dr. Jenny Kane. “Of course, the flip side is when you see people improve, when you know without a doubt that you’ve helped them. That’s a real high.” Psychiatrists must be perceptive, able to listen well, and able to work well with others. They must also be dedicated to a lifetime of learning, as new therapeutic techniques and medications are constantly being developed.
Exploring Psychiatrist Career
You can easily explore this job by reading as much as you can about the field and the work. To find out what professionals consider worthwhile resources, you may want to read the Authoritative Guide to Self-Help Resources in Mental Health by John Norcross and others (Guilford Publications, 2003). To learn about different types of psychotherapies, you may want to read Essential Psychotherapies: Theory and Practice, edited by Alan Gurman and Stanley Messer (Guilford Publications, 2003). Talk with your guidance counselor or psychology teacher about helping you arrange an informational interview with a local psychiatrist. If this is not possible, try to get an informational interview with any physician, such as your family doctor, to ask about the medical school experience.
An excellent way to explore this type of work is to do volunteer work in health care settings, such as hospitals, clinics, or nursing homes. While you may not be taking care of people with psychiatric problems, you will be interacting with patients and health care professionals. This experience will benefit you when it’s time to apply to medical schools and will give you a feel for working with those who are ill.
As a college student, you may be able to find a summer job as a hospital orderly, nurse’s aide, or ward clerk.
Approximately half of practicing psychiatrists work in private practice; many others combine private practice with work in a health care institution. These institutions include private hospitals, state mental hospitals, medical schools, community health centers, and government health agencies. Psychiatrists may also work at correctional facilities, for health maintenance organizations, or in nursing homes. They are employed throughout the country.
Psychiatrists in residency can find job leads in professional journals and through professional organizations such as the American Psychiatric Association. Many are offered permanent positions with the same institution where they complete their residency.
Most psychiatrists advance in their careers by enlarging their knowledge and skills, clientele, and earnings. Those who work in hospitals, clinics, and mental health centers may become administrators. Those who teach or concentrate on research may become department heads.
Psychiatrists’ earnings are determined by the kind of practice they have and its location, their experience, and the number of patients they treat. Like other physicians, their average income is among the highest of any occupation.
The median salary for a general psychiatrist in 2004 with over a year in their specialty was around $180,000, according to the U.S. Department of Labor. According to Physicians Search, a physician recruitment agency, average starting salaries for psychiatrists ranged from $110,000 to $180,000 in 2004. Psychiatrists who have practiced for three years or more earned salaries that ranged from $121,000 to $189,499. The median for psychiatrists was $163,144 in 2003, according to the Medical Group Management Association.
Psychiatrists in private practice set their own schedules and usually work regular hours. They may work some evenings or weekends to see patients who cannot take time off during business hours. Most psychiatrists, however, put in long workdays, averaging 52 hours a week, according to American Medical Association statistics. Like other physicians, psychiatrists are always on call. Dr. Jenny Kane likens the obligations of her job to parenting. “Whatever and whenever a patient needs me, it’s my job to be there—or at least to make arrangements to have them taken care of,” she says.
Psychiatrists in private practice typically work in comfortable office settings. Some private psychiatrists also work as hospital staff members, consultants, lecturers, or teachers.
Salaried psychiatrists work in private hospitals, state hospitals, and community mental health centers. They also work for government agencies, such as the U.S. Department of Health and Human Services, the Department of Defense, and the Department of Veterans Affairs. Psychiatrists who work in public facilities often bear heavy workloads. Changes in treatment have reduced the number of patients in hospitals and have increased the number of patients in community health centers.
Psychiatrist Career Outlook
The U.S. Department of Labor predicts employment for all physicians to grow faster than the average career through 2014. Opportunities for psychiatrists in private practice and salaried positions are good. Demand is great for child psychiatrists, and other specialties are also in short supply, especially in rural areas and public facilities.
A number of factors contribute to this shortage. Growing population and increasing life span add up to more people who need psychiatric care; rising incomes enable more people to afford treatment; and higher educational levels make more people aware of the importance of mental health care. Medical insurance, although it usually limits the amount of mental health care, may provide some coverage. However, the amount of benefits being paid out has been more than cut in half over the past 10 years.
Psychiatrists are also needed as researchers to explore the causes of mental illness and develop new ways to treat it.