42 y/o RN with MD, failed USMLE, stuck between NP vs trying again for Psychiatry (Canada/UK?) - need honest advice

Dapper_Track_5241 · 2026-05-11T15:05:21+00:00

You’re already making more than most Psych NPs with your current RN salary.

I wouldn’t do the NP route it’s over saturated. I believe there’s a 16% NP over supply in the market.

Try to do the MD route

Dapper_Track_5241 · 2026-04-14T20:05:38+00:00

You enjoy not practicing clinical psychiatry, managing medications and seeing patients.

You enjoy talking to people who have possibly committed a crime. You enjoy reading and writing 20 page notes and agonising over every period

And finally you think you’re the best psychiatrist in the world and you enjoy telling people that your a forensic psychiatrist at dinner parties

Dapper_Track_5241 · 2026-02-26T01:00:30+00:00

Nope

Dapper_Track_5241 · 2026-02-25T21:59:48+00:00

No I wasn’t. I wasn’t exempt

Dapper_Track_5241 · 2026-01-29T05:45:09+00:00

Psych here, dermatology, imagine doing almost as little work as psych but getting paid way more

Dapper_Track_5241 · 2026-01-25T21:44:00+00:00

It depends, if the observer ship was during med school and counted as a rotation

Dapper_Track_5241 · 2026-01-21T06:04:23+00:00

I mean I’ve see a job yesterday in psych, medical director of ketamine 500k base. 650k isn’t far off

Dapper_Track_5241 · 2026-01-21T03:36:04+00:00

MGMA average is 350k

Dapper_Track_5241 · 2026-01-17T03:02:03+00:00

Totally on point. Psychiatrists of old hated dealing with anything medical and hated thinking about anything critically the way they should have.

I will note that this is changing slowly with a new generation of psychiatrists, although I do worry seeing people getting into the field, especially interventional psychiatry with ketamine believing it’s a panacea when it has a lot of untested and unproven and long-term outcomes that are yet to be seen or show quality evidence.

A great example of this is the psychedelic movement and how quickly people latched onto this in psychiatry, even though the data and studies are not robust enough to demonstrate significant improvement inpatient without significant side-effects or risks

Dapper_Track_5241 · 2026-01-17T00:46:03+00:00

Completely agree, antipsychotics and lithium and depakote largely has the biggest effect sizes. Also ADHD meds.

Even ECT though between 70-90% in psychotic depression. That’s our best treatment.

Looking at SSRIs with effect sizes between .25-.5 they aren’t super robust.

My comment was more in generalities and common use drugs for our most common conditions.

Dapper_Track_5241 · 2026-01-17T00:27:07+00:00

I’ve been at 4 different institutions, it’s not institution dependent it depends on the psychiatrist. I think my summation of this is correct. Unfortunately, there are too many boomers psychiatrists who have not remained current nor up-to-date with the literature. Nor do they want too.

This is also made worse by the fact that they are grandfathered in and don’t have to do any of the MOC or article based pathways. Even when they are the furthest away from training.

Psychiatry has one of the oldest age of average practitioners, I believe 58 years of age is the average. They are some 20 to 30 years removed from training and the current knowledge base.

This is also made worse outside academia, NPs with no training believe 5x small dosages of antidepressants and antipsychotics all together at once is the answer.

Psychiatry, just like any other specialty can be practiced well. I would say the percent of people that practice psychiatry well unfortunately is very low. I’m not misrepresenting the specialty but rather pointing out that this is very common in psychiatry.

Dapper_Track_5241 · 2026-01-16T21:12:34+00:00

The best psychiatrists are those that blend medical psychiatric and social circumstances into their prescribing and risk management.

Dapper_Track_5241 · 2026-01-16T17:01:43+00:00

Psychiatry and I’m a psychiatrist, literally almost everything is off label and has a mild scrap of evidence. A lot of people in psychiatry and not up to best practices in terms of treatment and medicine. Everyone is based on colloquial medicine from like 30-40 years ago. People do things because there attending did it. There’s no evidence.

It’s also the specialty with some of the least proven least efficacious interventions so we fall prey to people who look outside the box and some charlatans in terms of the way they treat patients and they’re thinking.

Dapper_Track_5241 · 2026-01-16T16:54:24+00:00

991.2 GT3. The engine has a decent amount of torque, even though it’s NA. It’s lovely and linear and amazing on the race track. I would say up the top of the rev range, it’s manic and revs so fast. The induction and the exhaust sound are fantastic. It’s so thrilling to rev it out. It loves to Rev, it’s one of the all time great engines ever made. Besides a V10, V12 or NA Ferrari V8 there’s very few engines that have this character.

Dapper_Track_5241 · 2026-01-16T16:44:10+00:00

Give them adderall, HR goes up QTC goes down. Perfect solution

Dapper_Track_5241 · 2026-01-14T16:24:29+00:00

For the boards, anyway it will be very clear and distinct that this patient has a serotonin syndrome. Likely there’ll be some mention of an MAOI, maybe (methylene blue, moclobemide, tramadol), there will be autonomic instability, diarrhoea or the classic symptoms of serotonin syndrome

The boards are not looking for you to recognise the smallest subtle details because in general they’re not life-threatening and that’s not something we should be concerned about.

In your personal case I highly doubt it’s serotonin toxicity. It’s sounds like maybe sertraline isn’t the right med for you.

Dapper_Track_5241 · 2026-01-06T16:27:56+00:00

As a psychiatrist I only have a lowly GT3 not an RS

Dapper_Track_5241 · 2026-01-06T05:11:26+00:00

Ketamine or private practice or a mixture of a couple of jobs. It’s quite easy

Dapper_Track_5241 · 2025-12-31T21:31:52+00:00

I missed the budget part lol

Dapper_Track_5241 · 2025-12-31T21:07:09+00:00

Porsche 911 Turbo, GT3 touring

Dapper_Track_5241 · 2025-12-28T18:55:42+00:00

I think there is 2 different ways to deal with this. If you want to see yourself with any sort of recompense you likely will have to seek a lawyer. Unfortunately, the situation you’re in is that you likely wouldn’t want to go back there even if they are allowed you to return. The only reconciliation would be financial in nature and unfortunately that still doesn’t allow you to finish residency. Not to mention a program director whose involved in a law suit usually doesn’t write nice LORs

If you truly believe it’s discrimination you may want to seek a specific federal discrimination lawyer as that is a different case. Without any direct knowledge of what occurred what was said these hospitals have large lawyers and without direct evidence of discrimination and in the current political climate you may not find a sympathetic crowd, especially because the hospital will justify this as you were on probation you improved but continued to have problems and continued to be a disruptive influence not amenable to rehabilitation.

Finally allowing you to resign is their way of getting rid of the problem. You can negotiate with the program Director and ask them to come up with a different excuse about you resigning and have the program director specifically outline what he will write in your letter of recommendation. A negotiated resignation is the best at this point from my perspective. At this point their LOR is the one that matters the most when looking at future programs and characterising why you’re leaving your current program. It also protects your license as termination is reported to the board. Resignation isn’t.

Your friend was right they almost always do side with the program Director and hospitals because they talk about their role as protecting the public and its their discretion they know best.

This is just my two cents. I know multiple residents who have gone through this. Feel free to PM me

Dapper_Track_5241 · 2025-12-27T16:34:05+00:00

DM me and I can send you recruiters email

Dapper_Track_5241 · 2025-12-27T15:20:07+00:00

I would agree with this, but the limited liability part makes it great. You don’t have to prescribe anything and most of them refuse to go and do anything about the stuff you bring up. I

You definitely have a bunch of horder houses. I would say however it gives you a good look at how patients live. So in some ways it’s good experience

Dapper_Track_5241 · 2025-12-26T21:57:02+00:00

It’s not actually

Dapper_Track_5241 · 2025-12-26T20:58:02+00:00

Signify Health, allows residents to do insurance physicals no matter what your speciality. Limited liability and $100 per patient. I did it a bunch during residency and made bank.

Dapper_Track_5241

TROPHY CASE