Considering a career in psychiatry? In this article, psychiatrist Dr Tanveer Ahmed provides his reflections on the psychiatry specialty and what it’s like working as a psychiatrist.

I became attracted to the specialty because it seemed to be especially interdisciplinary, straddling both the metaphysical and the social sciences.

All doctors have the privilege of gaining instant access to the most intimate aspects of their patient’s experience, but this reached another level when assessing mental health patients.

The job is about stories, symbols and words but with a mingling of neuroscience to give it a harder, physiological edge. Mental health is really comprised of three different intellectual disciplines – neuroscience, behaviorism and psychoanalysis.

A sometimes-misunderstood specialty

Psychiatrists have been called secular priests, shrinks or trick cyclists. People who meet you at parties are either intrigued or threatened, but rarely in between.

Gone may be the stereotype of the bearded, bespectacled gentleman softly requesting you to lie on a couch. Nor are there many psychiatrists still working in Victorian-style asylums.

The modern reality is more of a technocratic office worker, attached to a desktop but still undertaking a task that British psychoanalyst Adam Phillips writes ‘reveals with scientific sobriety the slapstick of ordinary life’.

When I first chose psychiatry there was still considerable stigma about the choice. There was a view that few of the top graduates pursued the specialty. I think this has thoroughly changed. It still attracts those attracted to complexity, the human experience and many takers debate between specialties like neurology or emergency. Most like to take their time to make decisions and are not necessarily the stereotypical people of fast action.

Psychiatry has become a much more mainstream choice. This is aided by over a decade of public awareness campaigns and increasing growth in help-seeking attitudes and behaviour in the community concerning mental ill health. While we should be concerned about more facets of the human experience becoming medicalised, it is positive to see the rise of psychiatry as an important element in treating mental illness.

The broad umbrella of mental health also means there are greater overlaps with other sectors like the law, disability or workplace assessments.

Working as a ‘Specialist Generalist’

The field remains one of the few medical disciplines where one can be a ‘specialist generalist’, especially if you want to practice and live in a major city.

My average week varies from seeing adolescents with their families assessing anxiety disorders, to treating involuntary psychotic patients in a public hospital, to giving evidence in court for criminal trials. I even engage in procedures such as administering electroconvulsive therapy.

This is in contrast to colleagues who may only do one specific operation day in and day out or manage a narrow subspecialty within their field.

Since the pandemic there has understandably been a greater shift to telehealth, which has allowed the flexibility of working from home. As part of my community health job, I even do home visits which can vary from housing commission estates to a local detention centre. I once assessed someone living in a room attached to a brothel.

Challenges and the future of psychiatry

The rewards are wonderful but come more slowly in the recovery of psychiatric disorders, especially as the origins are usually developmental. This is also the key challenge as the problems are usually embedded in complex systems that are not easily influenced by blunt medical interventions.

The career will not suit those who are frustrated by the grey and uncertain.

Seeing transformation in patients leading more fulfilling lives is within reach, however. Like all modern health care, effective treatment depends upon team-based delivery with dedicated allied health staff.

The field also holds considerable promise ahead with potential new treatments like psychedelics or novel forms of electrical stimulation being explored.

Considering a career in psychiatry?

There is much to commend a career as a psychiatrist. Like any specialty, it is best to undertake a term and speak to others already practicing in the field.

It is also worth remembering that what is accessible in hospital training is often a narrow part of what most consultants ultimately undertake.

This is why it’s especially important to speak to people outside of the traditional training, hospital network. This will give a much better sense of the range of work on offer and the trajectory consultants take as they mature.

Disclaimer: Any patients mentioned in this article have been deidentified and created for the purposes of this article. This article may represent the views of the author and not necessarily the views of The Royal Australian and New Zealand College of Psychiatrists ('RANZCP'). By accessing the article you also agree to the RANZCP Website Terms of Use Agreement.