Choosing Your Medical Specialty: Psychiatry

April 18, 2022 | Claire Gagné


What's it like to specialize in psychiatry ? How much does a psychiatrist in Canada usually make? This article tells you more about the specialty.

"For anyone who is a genuine student of humans, and wanting to think and learn about them — psychiatry is a great specialty option," says Dr. Alison Freeland, Vice President of Education, Academic Affairs and Patient Experience at Trillium Health Partners, and Associate Dean, Mississauga Campus, at the Temerty Faculty of Medicine, University of Toronto.

Psychiatry is also one of the most in-demand specializations in Canada, with an average gross salary of around $287,000/year. It is a medical specialty that deals with the diseases of the mind, in which psychiatrists use a combination of biological, psychological and social treatment modalities to care for the patients.

To become a psychiatrist you need to go to medical school and then do five years of residency, with the first one being a general rotation and then the last four focused on psychiatry. At that point, you'll be a general psychiatrist. If you want to do a sub-speciality, that can take another year.

What are some options for working in psychiatry?

When you work in psychiatry you can either do hospital-based care, set up a practice in the community, or do a combination of both, explains Dr. Alison Freeland.

You can also choose to specialize in general psychiatry, where you often focus on adults or one of three subspecialties:

  • Child and adolescent psychiatry: Child and adolescent psychiatry is typically family-based, as patients are often too young to see the psychiatrist on their own, explains Dr. Freeland. "Adolescence is often where more serious mental illnesses can first start, like schizophrenia, or bipolar, or depression," and people also start to experiment with substance abuse. You may also treat developmental issues or issues related to school.
  • Geriatric psychiatry: Geriatric psychiatry focuses on people over the age of 65 with mental health issues. "An elderly person who may begin to experience cognitive disorders, such as dementia, may also have an onset of depression or anxiety that comes with it," says Dr. Freeland, who adds that in geriatric psychiatry, you're also working with the families looking after the elderly.
  • Forensic psychiatry: This subspecialty focuses on the intersection between mental healthcare and patients who have interfaced with the law. "We're looking at things like 'not criminally responsible' assessments — a lot of court-related work," says Dr. Freeland.

What are the challenges of being a psychiatrist?

There's increasing demand for mental health care currently, which means psychiatrists are very busy. "With increasing demands, the focus for a psychiatrist becomes more and more on providing emergency and acute and crisis care," says Dr. Freeland. "Sometimes doctors feel they are not given the time to be able to provide longer-term care because we are focusing on short-term crisis care these days."

What are some opportunities in psychiatry?

  • Many practicing psychiatrists are older, which means quite a few may be retiring in coming years, notes Dr. Freeland.
  • Psychiatry may provide the opportunity for a good work-life balance if you have your own clinic and set your hours. "I see people gear up and gear down in terms of the amount of busyness and interests that they have over their careers," says Dr. Freeland.
  • The skills you learn about understanding people will also help you if you want to do more administrative work, as you'll have to work effectively with others. Psychiatrists may also make good educators, able to understand challenges students face, notes Dr. Freeland.

What are some misperceptions of psychiatry?

You may think in psychiatry you won't use most physical health skills you learn in medical school, but that's not the case, says Dr. Freeland. "Most patients have both physical and mental health issues at the same time. Particularly if you work in a hospital setting, you'll be doing physical exams, working with medical colleagues and collaborating care with family doctors."

The treatment side of psychiatry may have physical effects. "The medications we use are very complex with lots of interactions you need to be aware of, and lots of physical health-related side effects to manage when you're prescribing medications. The robust training you get in medical school is absolutely used in psychiatry in terms of understanding that," says Dr. Freeland.

What are the advice for students interested in psychiatry?

Dr. Feeland suggests if you're interested in psychiatry, reach out to a number of practicing psychiatrists to learn about different types of work and what their journeys in the field have been.

"Sometimes people think it's just about sitting in an office and psychoanalyzing people," says Dr. Freeland. "The overlay of understanding of how to treat mental illness, and that interface with physical illness is very interesting. I find it to be a very creative specialty."

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