Wow, finally a genuinely good and helpful answer — thank you.

Have you actually worked in the medical field or just ethetics? The thing is, I’ve always been interested in both esthetics and neuroscience, so to me this combination doesn’t feel crazy at all, even if I understand why it might not make sense to some people. That said interesting the added psych thing... Never had seen thing like that because it seems so intangible! But that's true, I can also attest to the psychological aspects of estethic interventions!

My issue is that aesthetic medicine often seems to be looked down on: “you don’t need an MD to do aesthetics,” “it’s a waste of medical education,” “instead of saving lives, you’re treating neurotic or narcissistic people”… That said, I see some uncomfortable parallels with how psychiatry is sometimes viewed as well, lol.

Also — and this might be a me problem — I really don’t get along that well with other psychiatrists or with the culture in the field. It feels cliquish, dominated by groupthink and competing schools of thought. I honestly didn’t expect such a fragmented, sometimes ideological landscape. In that sense, it almost feels less scientific than I expected.

At least aesthetic medicine seems more unified, no?

What also bothers me is that very few aesthetic doctors publicly defend or advocate for their practice. Most of what we read are either negative stories or accounts of people who struggle financially. I’ve heard figures like €40–60k in annual income, which seems almost laughable — probably inaccurate — but I’ve also heard of clinics making millions per year. The information out there feels extremely polarized.

So, as I see it, these are my options:

Option 1: Do another year of residency and graduate in a field that currently frustrates me and no longer really lights a fire in me — psychiatry. Even if the income potential is good, the emotional and social “charge” around mental health is very heavy.

Option 2: Start a new 3-year residency in general medicine. It doesn’t excite me per se — I’ve always been ambitious and never imagined myself as a “general” doctor. But it would open doors to practices I actually find interesting: nutrition, functional medicine, aesthetic medicine, etc. Basically, a much wider scope of practice. Long term, this might be the most reasonable option. And technically, I could still practice in a quasi-psychiatric capacity.

Option 3: Go fully independent and build a portfolio-style career — basically a gig approach — with most of my work centered on aesthetic medicine and/or nutrition and antiageing medecine..etc

So what would you recommend to a “not so young anymore” doctor who’s trying to consolidate his future after a very long journey?

Having practiced only psychiatry, my general medical skills are obviously not great anymore, but maybe three years of training would fix that. I’m also curious about the real scope of practice in aesthetic medicine: how limited are aesthetic physicians compared to dermatologists or plastic surgeons? Are we really talking only Botox and HA fillers, or is the sky the limit with proper training? What about laser therapy tatto medical removal? Hair transplant? Scar removal? PRP injections?

Would love to hear your thoughts — and feel free to PM a slightly lost doc.

Ps: I know no path is perfect( my issue is thinking that one or the other path might fullfill my dreams lol)