The Psychiatrist : Clinical and Therapeutic Journal
Open Access

As a Professor of Psychiatry at Weill Cornell Medicine in Qatar, I am frequently asked by a small number of medical students whether a career in psychiatry is a good choice for them? My answer has evolved slightly over the years but I have never been as enthusiastic about the choice of psychiatry as a specialty as I have in recent years.

Of course a career in psychiatry is not the obvious choice for any student looking for a specialty to train in. However, if you are a medical student who is intellectually curious, psychologically-minded, who cares about the person as a whole and looking for a balanced work-life situation, then you better give psychiatry a serious consideration. Why? Here are some reasons:

• The need for psychiatrists is as high now as it has ever been. In the USA, the need for psychiatrists is second only to that of primary care physicians [1]. The need in other parts of the world is even more acute, with some developing countries boasting rates of psychiatrists as low as 1/650,000 people [2].

• Psychiatric disorders are increasingly common and are causing more disability worldwide than ever before. According to the WHO, unipolar depression alone is currently the second cause of disability worldwide, second only to coronary artery disease; it is projected to be the leading cause of disability by 2020 [3].

• Most psychiatric conditions are easy to recognize. The DSM- 5 and the ICD-10 present clear and objective criteria for the diagnosis of most psychiatric conditions. The ICD-11 which is expected to be adopted worldwide soon will attempt to close any existing gap between the two classification systems.

• Treatment in most cases is readily available. Whether in the form of pills or psychotherapy, there is clear evidence that many of the currently available therapies work.

• Advances in the neurosciences are occurring at a very fast rate. Progress in the fields of genetics, molecular biology, neuroimaging and neuropharmacology are providing us with more insights into the normal functioning of the brain, the biological basis of mental illness and the possible mechanisms of action of different therapeutic modalities.

• We are more aware than ever before of the strong and bidirectional relationship between medical and psychiatric illnesses. Many serious medical disorders are often accompanied by psychiatric symptoms and psychiatric conditions often precede and/or present risk factors for serious medical illness. A good example is major depression which is considered an independent risk factor for the development of coronary artery disease [4].

• Our understanding of the relationship between the brain and the mind is evolving in new directions. We know for instance that early psychological trauma can disturb the normal wiring of the brain, thus predisposing to future psychiatric and/or medical conditions. We also know that medications can alter brain circuitry, but that a similar effect can be seen with effective psychotherapy alone.

• Positive psychology and wellness are an integral part of the “whole person” approach to medical care. A healthy diet, exercise, meditation and/or yoga are essential ingredients of a healthy lifestyle that will hopefully help keep serious illness at bay.

• While stigma remains a major challenge for people suffering from mental illness, there is progress in that regard, due in part to the many educational campaigns that have often been joined by celebrities that have openly talked about their own struggles with mental illness.

• The wide reach of the internet, artificial intelligence and social media has reached psychiatry. Telemedicine is being used to treat psychiatric patients in remote areas; smartphone applications are being developed to help in the management of patients with various psychiatric disorders.

• While sophisticated technology and robots are slowly taking over several aspects of the health care delivery system, there is more need than ever before for empathy and the humanistic approach in dealing with patients; psychiatry will never be too far away from its deep humanistic roots.

• A career in psychiatry can provide the physician with a good life-work balance. Recent surveys show psychiatrists in general are happy with their career choices; the burnout rate is relatively small and most psychiatrists surveyed said will choose psychiatry again if they had to do it all over [5].

This is admittedly a very optimistic and enthusiastic view of the field. There are certainly those among us who lament the lack of real progress in diagnosis and treatment of mental illness. To those I say: Welcome on board. Your work is cut out for you. The sky is the limit.