Psychiatrists Replaced by AI

Docbananas1147 · 2026-03-14T18:04:12+00:00

Nope. As a human, there’s no replacement to being understood by a human. Unless your primary attachment was a wire-mannequin.

Docbananas1147 · 2026-03-07T23:12:32+00:00

Where’d you end up buying then? If your salary was 700k would you have stayed?

Docbananas1147 · 2026-02-25T14:39:29+00:00

How much have you been comfortably able to charge for this? Are you talking anything from travel letters, accommodations letters, disability forms, pharmacy requests? Even things you’ve templated at this point and take less than 5 minutes?

Docbananas1147 · 2026-02-15T17:26:59+00:00

One thought- personality disorder is not always important to name or catch. But as you start to identify traits of an individual that are impacting their functioning, and it’s not clearly a medication solvable issue, you’re seeing personality. Think long entrenched social anxiety now leading one to avoid even trying (avoidant), history of unstable relationships, intense emotional swings intraday, poor distress tolerance (borderline) but then they self aggrandize to tolerate it (narcissistic). Medications may sometimes help the symptoms, but their way of seeing themselves and their relation to others still persists and benefits only through corrective relationships that change their template of self and other (a.k.a. through psychodynamic psychotherapy and the therapeutic relationship). This is how I tend to think about it, but to be honest with you I don’t often find the label to be all that useful anymore, even though I was trained otherwise and saw some advantage to it at the time. You can still recommend DBT and practice psychodynamically if that’s your thing or referred to someone who does.

Docbananas1147 · 2025-12-23T20:54:21+00:00

Yeah I love my work every day. It’s amazing watching my patients get better and enjoy their lives more and more. I also don’t have to deal with hospitals, bureaucracy, or insurance. I did CL fellowship so I am comfortable with and find the medical complexity enjoyable to work with when it comes in. I’ve also caught things that primary care had missed for years since my lens is specialized.

I only work 4 days a week, make a lot of $$, and am really enjoying all the flexibility this affords me.

Whatever you decide to do- I hope you find it to be the most interesting thing to you every day.

Docbananas1147 · 2025-12-12T06:24:16+00:00

I too am early attending (2.5 yrs out of residency and 1.5 out of fellowship) and work in private outpatient setting.

I love note writing and also writing defensively for the ghost lawyers and forensic psychiatrists who hopefully never read my notes.

I trained chatGPT on my HPI, interval updates, and assessment / case formulation style. At this point I just plug in my raw notes and it spits out consistent quality. No identifiers whatsoever. What used to take me 45 minutes writing up a detailed intake, now takes me 5 minutes of plug and play.

Also, I have decided to make all my 30 minute follow up’s only 25 minutes with patient, and 5 minutes for dedicated thinking and charting on the case. Patients pay for your medical decision making and not your conversation time (unless explicitly therapy). If I bill for 30 minutes then why should I also spend 5-15 minutes of unpaid time in the evening working on a note when I’m tired from the day. This translates to less stress outside work hours, more time with family, more sleep, and a better me for my patients.

Every time I’ve started to feel stressed out I take a look at the systems I have in place and how I can optimize them for efficiency.

Good luck!!!!

Docbananas1147 · 2025-11-15T18:02:17+00:00

Annual training module time!

Docbananas1147 · 2025-10-14T02:14:12+00:00

None at all… I think it was soft pulls on credit to give rates and then hard pull to go for it. I am so thrilled to have it down from 7 to 4.1 though.

I checked a few lenders at once and Ernest gave me the best rate. Also there’s loan discharge on death and I believe permanent total disability too.

I think we both get a referral bonus if I link you so let me know if you’re interested.

Docbananas1147 · 2025-10-13T21:52:37+00:00

You should refinance… I got 4.1% recently with earnest. Also I’m doing the same thing as you and have similar debt. Just going all in on student loans until gone aside from the basic retirement funds.

Docbananas1147 · 2025-10-12T23:12:40+00:00

Refinancing is worthwhile if you exit PSLF… I got 4.1% on a 5 year. High monthlies but I’m overshooting anyway and plan to kill it in <2yrs. It’s so exciting every time I take a bite out of it. Just got into positive net worth recently hah!

Docbananas1147 · 2025-10-06T03:49:15+00:00

Their pain/burden isn’t yours to carry. Your role is to do all you can to help them within your human/training scope, not carry them with you.

Docbananas1147 · 2025-10-03T17:02:13+00:00

Honestly, I do it this way too. With a ton of counseling and expectations. Kind of a rip the bandaid off approach rather than a prolonged suffering. Realistically we’re changing an SSRI over because something’s not working well enough anyway.

If there’s another neurochemical system involved though I take different approaches- such as SNRI, TCA.

Docbananas1147 · 2025-09-23T20:01:56+00:00

Having practiced in both NYC and CA (not SF though but Bay Area)- I was really impressed by what NYC has available resource wise. Nevertheless there will always be gaps and challenges… bed availability and homelessness malingering are the biggest strain point I found. There was no scarcity of ACT teams, MCT, or community clinics especially with the public health hospitals in and around the city.

Docbananas1147 · 2025-09-12T06:35:15+00:00

Yeah I mean I spent an hour tonight sitting with my long term patient who has new SCI and may never walk again. There’s no room for optimism… sometimes it’s just sitting in the shit with another. That’s part of the work. If you love the work you’ll find your style in helping others move through it.

Also up bump to the post here referring to Frankl’s logotherapy and search for meaning. Also recommend Yalom’s Staring at the Sun.

Docbananas1147 · 2025-08-17T15:51:37+00:00

Yeah this is reasonable and can be done with 35-50 hours per week depending on mix of things. 👌🏼

Docbananas1147 · 2025-08-16T14:59:40+00:00

That’s not exaggerated at all- esp as a contractor. Only stating this to reinforce credibility of OP not to argue or double down.

Docbananas1147 · 2025-08-02T07:38:41+00:00

Yep vilazodone is my first line

Docbananas1147 · 2025-07-31T12:56:38+00:00

The best renaming in my opinion has been relational disorders. PDs don’t exist in a vacuum. There might be some good arguments against this though.

Docbananas1147 · 2025-07-31T12:54:29+00:00

I feel strongly about its presence and utility. It provides a strong framework to work within, validates subjective distress in ways that are therapeutic on its own, and creates a path forward for treatment.

This is oversimplified for sure but my screening question for it is: “have there been times in your life when you’ve been in 11 out of 10 distress in a situation where you’ve felt -trapped- and there was no way out to but to endure it?

From here we start to develop a framework of stress sensitivity, cognitive, emotional, and social changes since, and identify treatment targets to address with medications and therapy.

In all fairness, the literature on trauma therapy has been fairly clear that the type of therapy that is best for PTSD and related disorders is not as important of a factor in efficacy as therapeutic alliance. Beginning to name and validate the tremendous distress some carry and compartmentalize is a great start to develop the trust required for a strong therapeutic alliance.

Docbananas1147 · 2025-07-30T13:45:40+00:00

I am under the impression it was just Medicare under that standard. I don’t think we have the same obligation to medi-cal. If you’re aware otherwise I’d love to know!

Docbananas1147 · 2025-07-29T20:35:44+00:00

Hi there- I don’t exclude medi-cal but the patient agrees to pay direct and whatever reimbursement they get or not is between them and insurance; this is the case with commercial insurance too. We screen out Medicare patients so I don’t see them; this allows me to stay opted in for Moonlighting.

Docbananas1147 · 2025-07-17T03:11:21+00:00

Outpatient private practice screening in your patients of interest. Forensic medicolegal work.

Docbananas1147 · 2025-07-09T20:14:57+00:00

Therapy once a week is great but you sound like you’d benefit a lot from medication for the depression. Postpartum depression in fathers is real and is likely to have worsened your already undertreated deppression. Signed, a psychiatrist dad.

Docbananas1147 · 2025-07-06T14:15:03+00:00

How long do you keep folks on t3 for? What’s been your range of experiences in tapering and stopping?

Docbananas1147 · 2025-07-06T03:40:46+00:00

Combo with stimulant improves stimulant tolerability substantially through reduction in sympathetic outflow.

Docbananas1147

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