GP vs Psychiatry

IMG doctor in the UK frequently tell me that they are confused between choosing GP training or Psychiatry and ask for my advice.

I am a Psychiatrist, my wife is a GP. We were training and preparing for exams simultaneously , so I have some understanding of what is involved in GP training and as time has passed I have gained better understanding of the workload of GPs. So in this post I make a comparison of basic differences a Psychiatrist and GP based largely on my personal experience.

Disclaimer: This is written based on my own experience and other people may disagree. I am a Psychiatrist so I will be naturally biased towards Psychiatry  despite my best efforts to remain neutral.

Life of a Qualified GP or Psychiatrist:

Time allocated to see patients:

GP: 10 minute per patient,

Psychiatrist: 20-30 minute follow-up and 40-60 minute New patient (most cases)

Number of Patient seen in a day:

GP:  From 32 patients per day (40-50 if on-call) 2-3 average home visits daily.

GPs often refer to sessions. One session is roughly 4hrs. So a full day would be two sessions. Full time GP work around 9 clinical sessions.

Psychiatrist: 6 patients in a clinic (two clinics in a week for me)

My routine home visits will be maximum of two in a week.

Routine day:

GP: Daily clinics, frequent home visits, daily paperwork of results, letters and prescription queries. Liaison with district nurses, palliative care teams and midwives/health visitors varies on a daily basis.

GPs may have set minor surgery clinic, contraceptive clinic and baby clinic/ hospital clinic depending availability and own special interests.

Psychiatrist: Variety of job descriptions depending on the sub speciality, can include clinics, MDT meetings, community based jobs, home visits, inpatient and hospital based roles.

My Current job plan includes 2 clinics a week, one MDT meeting weekly, weekly ward round, some ward based meetings and weekly home visits. I am managing inpatients, community team and memory team.

Age and patient group:

GPs see all age groups and all varieties of medical conditions from simple conditions to complex cases. They are often the first port of call for medical care.

Psychiatry involves sub specialties that are also age specific focusing on different age groups and there are many sub specialities of Psychiatry, narrowing down the scope of work further. i.e super specialism

As an Old Age Psychiatrist most my patient are above 65 . Child Psychiatrists see patients up to the age of 18 years.

Uncomplicated mental illnesses is often managed by GPs for example simple anxiety and depression.

Workload:

GPs work much harder than Psychiatrist (at least in my household).

This simply include more patients for GPs and more paperwork.

Teaching research and becoming a trainer:

GPs: You can train to become a GP trainer and also develop the practice to support medical students placements. There are also routes to train as Academic GPs. GP trainers can train GP trainees from ST1-ST3. Most practices are affiliated with local medical schools and have medical students from year 3 and 5. My wife is also involved in training independent pharmacists and nursing students.

Psychiatrist: We are expected to train and supervise junior doctors even from our ST years. Quite frequently the new consultants are clinical supervisors for juniors and soon train to become educational supervisors.

There are plenty of teaching opportunities for senior psychiatrists, including medical schools, junior doctors and MRCPsych courses. Mental Health research is also getting significant funding and focus with some cutting edge research going across the UK.

Private and locum work:

There is a shortage of both qualified Psychiatrists and GPs across the UK. Plenty of locum work available.

GPs: Some local schemes offer Golden Hellos of up to 20K.  Private GPs and portfolio GP can enhance their earning. There are numerous opportunities to do locums and develop special interests.

Psychiatry: Opportunity to do locums, Section 12 assessments, DOLs assessments and private sector work.

Private companies are managing many psychiatric hospitals / units where consultant psychiatrist salary may start from £140,000 pa.

On-calls, Nights and Weekends:

GPs can choose hours independently and practices have flexibility and organise their own rotas. GP opening hours can vary locally but majority of practices working hours are 8am to 6.30pm. You may wish to work as a OOH GP only or do a mixture of both.

Qualified Psychiatrist are much less frequently on-call and do most on-calls from home. I do only one weekend every 3 months and one weekday on-call after every 20 days.

ST doctors in Psychiatry are also mostly on-call from home.

Scope outside UK

Good opportunity for both specialities to migrate to other in English speaking countries such as Canada, Australia and New Zealand. There have also been very successful recruitment to the Middle East.

Training years:

Training time to CCT: (In most cases)

GP: 3 years (18 months of hospital placement and 18 months in GP for my wife) Recent changes involve 12 months hospital based training and 24months GP based training.

Psychiatry: 6 years (3 years of Core and 3 years of ST training)

Membership Exams:

Both training requires work place base assessments (WPBAs), evidence that you are covering curriculum and to pass the ARCPs

GP (MRCGP) = AKT and CSA

Psychiatry (MRCPsych) = Paper A and B (2 MCQ papers) and CASC (OSCE style practical exam)

Psychiatry membership exams are required to progress to the ST training.

No exit exam in Psychiatry during ST training

Salary:

Similar pay scales as trainees and post qualification for GP and Psychiatrist.

GP Salaried positions have fixed salaries, partners take drawings based on practice performance and enhanced services. GPs can also work for local health boards for fixed no. of sessions or part of NCN groups.

There are plenty of opportunities to earn extra by exploring different options for both GP and Psychiatry. Locum opportunities  are available for both specialties.

Rotations during training:

GP: Rotate between mixture of hospital and GP placements

GP trainee remain relatively local but usually expected to drive and can be sent to GP practice some miles away but close networking with programme directors allows to have flexibility of training at closer practices if required. Hospital based training can be at different hospitals within a trust.

Psychiatry: Core trainees rotate between different subspecialties of Psychiatry and ST trainees rotate in one or two particular specialities of their choosing.

Psychiatry ST trainees also move between different trust within a deanery. My ST training was spread across three different trust in Wales.

CCT:

Following completion of training and membership exams GPs register on a Medical Performers list locally and also the GMC GP register.

Psychiatrist register on the GMC specialist register and there are six different types of CCT for Psychiatrists. (General adult psychiatrist, Old age Psychiatrist, Child psychiatrist, LD psychiatrist, forensic psychiatrist and medical psychotherapy)

What happens if I couldn’t pass my membership exam or ARCPs?

GPs: You will leave GP training without qualification and will not be able to work as a GP.

Psychiatry: You can still work as a Psychiatrist at a speciality doctor level and some even progress to become locum consultants without membership exams and CCTs. You also have the option to take CESR pathway to become a substantive consultant.

Once you have around 3 year experience as a psychiatry junior doctor, you can secure, with relative ease, agency locums as a speciality doctor job and earn up to £80,000 – £100,000 per year.

I frequently say to juniors:

The advantage of choosing GP maybe shorter training period but you will hit the ground running and take on the duties of a seasoned GP immediately. There is more flexibility in working hours and days but your day can be particularly long with a heavy case load. You are often working alone so good supportive colleague and a good efficient team are important to support your working day.

So be careful as by choosing less training time, you may end up with an extremely busy job. So choose the speciality depending on your passion and interest.

This might come to you as a surprise that GPs see more mental health patients than psychiatrist. Research suggest that about 40% of GP appointments are mental health related. A huge variety in clinical conditions and build-up of close connections with patients from cradle to grave still underpins most GP models.

Reference: https://www.mind.org.uk/news-campaigns/news/40-per-cent-of-all-gp-appointments-about-mental-health/

So if you are choosing GP to avoid seeing mental illness you may be in for a surprise.

Best Wishes

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