9 answers
Trevor
Student
Las Vegas, Nevada
1
Question
Asked
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What are some things you wish you knew before entering the medical field?
I'm interested in becoming an RN and someday a psychiatrist. I want to learn some things that might have caught you off-guard or surprised you about working in these fields.
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9 answers
Rita Chuang
Physician
188
Answers
Henderson, Nevada
Updated
Rita’s Answer
Hi Trevor. I'm from California but moved to Henderson, NV over 20 years ago. We are neighbors.
I love this question. This is my advice. I would either be a RN or MD/DO. To do both would be very difficult because of the time it takes as well as the cost of schooling for both. If you want to be a psychiatrist and did not become a RN first, you would be about 30 years old when you finish residency and that's if you do not take any breaks between college, medical school and residency.
This is the timeline for medicine:
4 years college
4 years medical school
4 years psychiatry residency
I don't know the time it takes to be a RN but add that to the above and I'm assuming you will want to work as a nurse after you finish nursing school. How old will you be if you need to do both? Also, do you plan to have a family? If so, the pressures of taking care of the family will make it more difficult to go back to school because you need to pay bills and take care of the family. Plus, when will you study? Will you just get loans to pay for everything?
So, what are your options:
1. Just go to medical school and forget nursing
2. Become a RN and become a nurse practitioner who practices psychiatry--this will take less time but you will make less money
I suggest anyone interested in medicine work as a medical scribe. They pay you (but not a lot and you are not doing it for the money), you learn the language, you can interact with physicians and get an idea of what work will be like, and this will help you in your future in medicine because they are teaching you for your future. The medical students who worked with me who worked as scribes were so much sharper. I don't necessarily believe they were smarter but they had the exposure so they were ahead of the game.
I was in shock when I went to medical school. The volume of information that I needed to memorize was unbelievable. This is how scribing will help. There was a week that I cried every day. I had patients that were studying nursing who had to take sleeping pills because they could not sleep due to anxiety. Although I was never #1 in high school or college, I was at the top of my class. When I was in medical school, I was happy to just pass and that's not me. I became depressed and my self-esteem dropped. Everyone was so smart and worked hard.
I was also very shy. I hate public speaking. The first two years of medical school, you are in the classroom and the second two years, you start your rotations in different fields. I was now forced to speak during the rotations. To let you know the degree of my shyness, I was voted the shyest girl in high school. They ask you questions in front of others and the people that shined can answer the questions and were better at socializing. This continues during residency. If you are shy, you need to work on this and get a job or do something that forces you to get out of your shell. Get any job that makes you talk and deal with people. I think part of the difficulty with medicine or any job is learning how do deal with people.
I worked as a family medicine doctor. At first, I worked for a company and then I opened my own office. Working in Henderson, there are not enough doctors and at the start of my practice, it was slow. Because of the shortage of doctors, you will quickly be busy. I was suddenly seeing 40 patients a day and going to the hospital to see those patients. I was working on Saturdays trying to catch up (not seeing patients but paperwork). I think in 8 years, I took one personal day off and I burned out. When you can't see patients, they get upset and sometimes threaten to leave you so that's why we squeezed the patients in. I was once nice but I lost my empathy because I was so tired. It's not just seeing patients. You need to review notes from other doctors, answer telephone questions, call patients with lab results, renew refill requests besides other things like opening the mail, doing payroll for my staff, and paying office bills etc etc. I started seeing patients in the office at 8 AM but I would get up earlier (6-7 AM ) to go to the hospital to see those patients and eat breakfast while I reviewed labs, answered patient questions, and refilled medications. There are "after hour" questions and if it's your own practice you need to decide if you want to take these calls or pay someone to answer them. I would get irritated when I get calls at 7:30 AM from patients when the office opened at 8 AM. I closed the office Wednesday afternoons to do payroll and often ate lunch at 3 pm. I had one patient knocking at my back door trying to get in while we were closed.
I also did not know what I was getting myself into when I went into medicine. It's long and hard. It's sometimes depressing and lonely. Most days, all I hear are complaints all day long. When I get home, I just need time for myself without anyone asking something from me. I also would dig deep inside and ask yourself why do you want to get into medicine. These are common "truthful" answers:
1. money
2. esteem
3. parental approval
4. love of medicine-mental stimulation
5. love of people and helping them
If your answer is 4 or 5, medicine is for you. If it's any of the above 3, you can do your job but it can be a difficult road. It takes a special person to become a doctor. It's a long road and not easy.
Also, when you are a doctor (at least you are looking at psychiatry), I get questions from family members and friends all the time. During Christmas, I need to hear the long story of my uncle's heart procedure and should he be on certain medications. I get text messages from my cousin for his kids-what's this rash. Someone has a fever and what's the cause. My sister's friend's father wants medication.
My friend works for a big company as an internal medicine doctor. She has a very high patient satisfaction (I think about 93%) but she is constantly late (over 1 hour) for each patient because she spends the time with them and her company had a "meeting" with her because of this complaint. I called her to wish her a happy birthday at 9 PM and I was shocked to learn she was still at the office finishing her notes. At her company, you can email your doctor questions so she was telling me how after work, she has to answer the questions from patients.
The burnout for physicians is very high. You need to learn how to deal with burnout. Most doctors keep pushing themselves. I did this but I ended up retiring early. I sold my practice and the work was so much easier when I worked for someone else but I heard patients complain all the time because they could not get in. They could not email questions to me whenever they wanted. etc
In terms of your salary, you will make a decent salary and be able to pay your bills but there is a problem in medicine. I know this because I opened my own practice. Insurance companies pay you by a code. You get paid more if you see a new patient and if you code higher. The problem is that in the last 20 years, the majority of insurance companies have not increased the pay for that code. In fact, Medicare decreased how much they paid doctors per code this year. So if you own your own practice, your utilities increase yearly, rent increases, the pay for staff increases because everyone wants a raise. If you are paid the same amount per code, in order to survive, you need to increase how many patients you see a day to survive. This is very unfair because the insurance companies increase how much we need to pay each year for insurance but they don't share it with doctors. Your staff in your office is good at finding jobs that pay more. The bigger companies can pay them more, give them better benefits etc. I had several doctors calling me asking if they could hire any of my staff. From a few of my friends that are paying $20 per hour for staff member, if you have 3 staff members, that's $60 per hour. For an existing patient that you code 99213, one insurance company pays you $32.72. If you see 4 patients an hour at that rate (15 minutes per patient), that's $130.88 per hour that you will make but subtract the $60 for the employees, and subtract rent, utilities, malpractice insurance, billing, etc, there's not much left for you.
If you truly love medicine, go ahead and do it. Know it will be a long road and it will be difficult. There are many problems in medicine but I think every job has it's problems. I hope they will be able to fix a lot of these problems. Good luck.
I love this question. This is my advice. I would either be a RN or MD/DO. To do both would be very difficult because of the time it takes as well as the cost of schooling for both. If you want to be a psychiatrist and did not become a RN first, you would be about 30 years old when you finish residency and that's if you do not take any breaks between college, medical school and residency.
This is the timeline for medicine:
4 years college
4 years medical school
4 years psychiatry residency
I don't know the time it takes to be a RN but add that to the above and I'm assuming you will want to work as a nurse after you finish nursing school. How old will you be if you need to do both? Also, do you plan to have a family? If so, the pressures of taking care of the family will make it more difficult to go back to school because you need to pay bills and take care of the family. Plus, when will you study? Will you just get loans to pay for everything?
So, what are your options:
1. Just go to medical school and forget nursing
2. Become a RN and become a nurse practitioner who practices psychiatry--this will take less time but you will make less money
I suggest anyone interested in medicine work as a medical scribe. They pay you (but not a lot and you are not doing it for the money), you learn the language, you can interact with physicians and get an idea of what work will be like, and this will help you in your future in medicine because they are teaching you for your future. The medical students who worked with me who worked as scribes were so much sharper. I don't necessarily believe they were smarter but they had the exposure so they were ahead of the game.
I was in shock when I went to medical school. The volume of information that I needed to memorize was unbelievable. This is how scribing will help. There was a week that I cried every day. I had patients that were studying nursing who had to take sleeping pills because they could not sleep due to anxiety. Although I was never #1 in high school or college, I was at the top of my class. When I was in medical school, I was happy to just pass and that's not me. I became depressed and my self-esteem dropped. Everyone was so smart and worked hard.
I was also very shy. I hate public speaking. The first two years of medical school, you are in the classroom and the second two years, you start your rotations in different fields. I was now forced to speak during the rotations. To let you know the degree of my shyness, I was voted the shyest girl in high school. They ask you questions in front of others and the people that shined can answer the questions and were better at socializing. This continues during residency. If you are shy, you need to work on this and get a job or do something that forces you to get out of your shell. Get any job that makes you talk and deal with people. I think part of the difficulty with medicine or any job is learning how do deal with people.
I worked as a family medicine doctor. At first, I worked for a company and then I opened my own office. Working in Henderson, there are not enough doctors and at the start of my practice, it was slow. Because of the shortage of doctors, you will quickly be busy. I was suddenly seeing 40 patients a day and going to the hospital to see those patients. I was working on Saturdays trying to catch up (not seeing patients but paperwork). I think in 8 years, I took one personal day off and I burned out. When you can't see patients, they get upset and sometimes threaten to leave you so that's why we squeezed the patients in. I was once nice but I lost my empathy because I was so tired. It's not just seeing patients. You need to review notes from other doctors, answer telephone questions, call patients with lab results, renew refill requests besides other things like opening the mail, doing payroll for my staff, and paying office bills etc etc. I started seeing patients in the office at 8 AM but I would get up earlier (6-7 AM ) to go to the hospital to see those patients and eat breakfast while I reviewed labs, answered patient questions, and refilled medications. There are "after hour" questions and if it's your own practice you need to decide if you want to take these calls or pay someone to answer them. I would get irritated when I get calls at 7:30 AM from patients when the office opened at 8 AM. I closed the office Wednesday afternoons to do payroll and often ate lunch at 3 pm. I had one patient knocking at my back door trying to get in while we were closed.
I also did not know what I was getting myself into when I went into medicine. It's long and hard. It's sometimes depressing and lonely. Most days, all I hear are complaints all day long. When I get home, I just need time for myself without anyone asking something from me. I also would dig deep inside and ask yourself why do you want to get into medicine. These are common "truthful" answers:
1. money
2. esteem
3. parental approval
4. love of medicine-mental stimulation
5. love of people and helping them
If your answer is 4 or 5, medicine is for you. If it's any of the above 3, you can do your job but it can be a difficult road. It takes a special person to become a doctor. It's a long road and not easy.
Also, when you are a doctor (at least you are looking at psychiatry), I get questions from family members and friends all the time. During Christmas, I need to hear the long story of my uncle's heart procedure and should he be on certain medications. I get text messages from my cousin for his kids-what's this rash. Someone has a fever and what's the cause. My sister's friend's father wants medication.
My friend works for a big company as an internal medicine doctor. She has a very high patient satisfaction (I think about 93%) but she is constantly late (over 1 hour) for each patient because she spends the time with them and her company had a "meeting" with her because of this complaint. I called her to wish her a happy birthday at 9 PM and I was shocked to learn she was still at the office finishing her notes. At her company, you can email your doctor questions so she was telling me how after work, she has to answer the questions from patients.
The burnout for physicians is very high. You need to learn how to deal with burnout. Most doctors keep pushing themselves. I did this but I ended up retiring early. I sold my practice and the work was so much easier when I worked for someone else but I heard patients complain all the time because they could not get in. They could not email questions to me whenever they wanted. etc
In terms of your salary, you will make a decent salary and be able to pay your bills but there is a problem in medicine. I know this because I opened my own practice. Insurance companies pay you by a code. You get paid more if you see a new patient and if you code higher. The problem is that in the last 20 years, the majority of insurance companies have not increased the pay for that code. In fact, Medicare decreased how much they paid doctors per code this year. So if you own your own practice, your utilities increase yearly, rent increases, the pay for staff increases because everyone wants a raise. If you are paid the same amount per code, in order to survive, you need to increase how many patients you see a day to survive. This is very unfair because the insurance companies increase how much we need to pay each year for insurance but they don't share it with doctors. Your staff in your office is good at finding jobs that pay more. The bigger companies can pay them more, give them better benefits etc. I had several doctors calling me asking if they could hire any of my staff. From a few of my friends that are paying $20 per hour for staff member, if you have 3 staff members, that's $60 per hour. For an existing patient that you code 99213, one insurance company pays you $32.72. If you see 4 patients an hour at that rate (15 minutes per patient), that's $130.88 per hour that you will make but subtract the $60 for the employees, and subtract rent, utilities, malpractice insurance, billing, etc, there's not much left for you.
If you truly love medicine, go ahead and do it. Know it will be a long road and it will be difficult. There are many problems in medicine but I think every job has it's problems. I hope they will be able to fix a lot of these problems. Good luck.
Hailey Hamilton
Nurse
96
Answers
Canton, Georgia
Updated
Hailey’s Answer
I wish I had known before starting nursing how important a good management team is. A good manager can make or break a department.
Sandra Bonner
Registered Nurse
3
Answers
Smyrna, Tennessee
Updated
Sandra’s Answer
I agree with Hailey in that I wish I had known how much nurses eat their young. I have been a nurse for over 40 years, and I love the nursing profession, but I can tell you that for every job that I left during my career, it was not because I didn't love my job. It was because of poor management. If you want to become an RN, and you are also interested in psychiatry, you may want to become an RN first and work on a psychiatric floor to get some experience. I recommend that you consider looking into becoming a psychiatric nurse practitioner. You can make good money. Depending on where you are employed, your employer may pay for part of or all of your tuition to assist with you obtaining your master's in nursing to become a nurse practitioner.
Admission requirements for psychiatric nurse practitioner (PMHNP) programs can vary, but here are some common prerequisites:
Bachelor’s Degree: Most PMHNP programs require a bachelor’s degree in nursing (BSN) or a related field. Some programs accept registered nurses (RNs) with an associate degree, but a BSN is preferred.
RN Licensure: You’ll need
Hope this helps Trevor. Best wishes in your endeavors!!!
Admission requirements for psychiatric nurse practitioner (PMHNP) programs can vary, but here are some common prerequisites:
Bachelor’s Degree: Most PMHNP programs require a bachelor’s degree in nursing (BSN) or a related field. Some programs accept registered nurses (RNs) with an associate degree, but a BSN is preferred.
RN Licensure: You’ll need
Hope this helps Trevor. Best wishes in your endeavors!!!
Maureen Komperda
Nurse Practitioner
40
Answers
Elmhurst, Illinois
Updated
Maureen’s Answer
Trevor, you have chosen to very giving professions.
First, I would advise you to take a major look at your own self care before you step into either of these arenas. Both require a lot of giving so you need to make sure you take good care of yourself first. I have been in nursing 44 years but was burned out until about 10 years ago when I finally took my own advice and promoted my own self care. Don't be afraid to say, "No!" to overtime, extra weekends, etc. Your own time is precious and a hot commodity so don't give it up readily.
Many of the writers are correct, you can go to school for Primary Mental Health Nurse Practitioner (PMHNP) as it will fulfill both your goals but all my psych instructors advised us to get into self-therapy as you will be taking on everyone else's problems and providing assistance for patients/clients and not taking care of your own. Many PMHNP are prescribing to a lot of patients and not spending as much time helping with therapy.
I would say, figure out what in psych motivates you, is it the therapy, medication prescribing, or what that you desire.
Psychiatrists, like NPs, are doing a great deal of prescribing and not much therapy. Gook luck on your journey. Take care of yourself most of all.
First, I would advise you to take a major look at your own self care before you step into either of these arenas. Both require a lot of giving so you need to make sure you take good care of yourself first. I have been in nursing 44 years but was burned out until about 10 years ago when I finally took my own advice and promoted my own self care. Don't be afraid to say, "No!" to overtime, extra weekends, etc. Your own time is precious and a hot commodity so don't give it up readily.
Many of the writers are correct, you can go to school for Primary Mental Health Nurse Practitioner (PMHNP) as it will fulfill both your goals but all my psych instructors advised us to get into self-therapy as you will be taking on everyone else's problems and providing assistance for patients/clients and not taking care of your own. Many PMHNP are prescribing to a lot of patients and not spending as much time helping with therapy.
I would say, figure out what in psych motivates you, is it the therapy, medication prescribing, or what that you desire.
Psychiatrists, like NPs, are doing a great deal of prescribing and not much therapy. Gook luck on your journey. Take care of yourself most of all.
Marina Dawood
1
Answer
Tampa, Florida
Updated
Marina’s Answer
Choosing to step into the world of medicine is a major decision, so having some knowledge beforehand can be really helpful. A lot of people already in the field wish they had known these things earlier. Training Duration: Your journey into medicine will include undergraduate studies, medical school, residency, and perhaps a fellowship. This journey is quite long and challenging. Personal Commitments: Prepare yourself for putting in extra hours, especially during weekends and nights. This might take a toll on your social life and personal time.
Martin Schoen
APRN
281
Answers
Ocala, Florida
Updated
Martin’s Answer
Great effort! However, it's important to realize that you're considering two distinct career paths. If you finish your RN, you could become a nurse practitioner in the mental health sector, performing nearly all the tasks a doctor does. On the other hand, if you're thinking about psychiatry, you'll need a bachelor's degree, medical school, and a psychiatry residency to qualify for your boards.
Perhaps what I wish I'd known earlier, and I'm sure many providers would concur, is not the journey towards meeting the practice requirements, but the additional tasks needed for billing and documentation. Interacting with patients is generally straightforward and time well invested. The time I must devote to computer documentation of the visit, ensuring the billing codes are accurately entered and correspond with the visit notes, plus the administrative meetings, are all extra tasks I wish I'd been aware of earlier.
Perhaps what I wish I'd known earlier, and I'm sure many providers would concur, is not the journey towards meeting the practice requirements, but the additional tasks needed for billing and documentation. Interacting with patients is generally straightforward and time well invested. The time I must devote to computer documentation of the visit, ensuring the billing codes are accurately entered and correspond with the visit notes, plus the administrative meetings, are all extra tasks I wish I'd been aware of earlier.
Andrew Popp
3
Answers
Updated
Andrew’s Answer
I am not in psychiatric type nursing, I come from an intensive care background. I wish I knew prior to getting into nursing how much the quality of your manager determines a lot of your job satisfaction. You can work a floor where you really love the patient population, but if your manager is very difficult to work with to achieve your personal goals or is very reluctant to give you a day off for a doctors appointment, it will be very difficult for you to have a life outside of work or to advance your career. Also, nursing is a team sport. I would highly recommend shadowing on a floor before taking a position as a nurse, and ask the hard questions that are important to you. See if you fit in with that team because they become who you need to rely on in many ways once you are on a floor.
Christine Robinson
Nurse Case Manager
20
Answers
White Creek, NY
Updated
Christine’s Answer
Well I had a BS in Animal Science and that helped me greatly. I would see what you can Clep which means study the book on the topic and then take a test I took notes, underlined the important things and read them over and over. And over again. I had 2 small children, an on and off the farm job. There are also books you can Google that have practice tests also. Flash cards help also.
Linda Reynolds
I was a psychiatric nurse and Nurse Educator
1
Answer
Los Angeles, California
Updated
Linda’s Answer
As a psychiatric nurse I was surprised how unprepared I was by my nursing courses to actually talk to patients (any patient )in a therapeutic manner. I worked in University Hospitals where psychiatric resident doctors were also not prepared by their schools to relate to patients therapeutically. Study was all focused on disease and treatment. My suggestion , is to read as much as you can about therapeutic relationship and practice these communication techniques with others. In nursing school seek out a mentor who might help you with this skill. I believe it is at the heart of all nursing.