A personal note to my future patients...

In response to popular demand, I put together a brief look behind the scenes of one doctor’s education (mine). I hope that going a little off-beat, lending a more personal perspective on what is involved in becoming a psychiatrist might be more interesting and enlightening than the usual “Resume”.

Many people are unfamiliar with the differences in education and practices of various professionals with similarly sounding professions. For example:

Psychiatrists, Physiatrists, and Psychologists. Two of these groups are physicians (M.D's) who study the sciences (math, physics, chemistry, biology, etc) in college before entering medical school. The psychologists and neuropsychologists (PsyD or PhD) study a variety of (non-science) subjects of their choice in college before studying (in graduate school) those aspects of psychology that do not require a science background or medical training.

Physiatrists are medical doctors who pursue special, formal postdoctoral education after getting their M.D. for several years. They bear no resemblance to psychiatrists or psychologists other than the spelling of their specialty. They are specialists who focus on the whole patient as they help them overcome and recover from any number of disabling injuries and illnesses. They frequently work with physical therapists.

It surprises some people to learn that all M.D.'s get the same education (that includes heart surgeons, psychiatrists, obstretritians, endocrinologists and brain surgeons) for the first eight years of their formal education after high school. It is often equally surprising for many people to learn that Psychologists and Neuropsychologists (who are desevedly well-respected professionals) are not expected or required to take biology, chemistry, physics, medical physiology, higher mathematics, biostatistics, biochemistry, etc. -- all prerequisites of the most preliminary medical school level courses, particularly pharmacology.

I always knew that I would be a doctor, and was fairly certain that I would be a psychiatrist. When I was younger, I had the notion that there was something special about a psychiatrist that called for some life experience in addition to the schoolbooks, technical training, and all that the ivory towers of traditional education could provide. Using that premise as my excuse?, I proceeded to travel the world for a few years before starting my premedical college training.

Anticipating being a "healer" in the future, I had developed an early interest (from the 60"s on) in natural , holistic, herbal, and other "alternative" approaches. I had the good fortune to have a very prominent expert in nutrition as my professor in my medical school nutrition course. One interesting occurrence in that course was the frequent visiting talks given by a Nobel Laureate who was very big on Vitamin C. My very first lecture to other doctors as a graduate doctor was about the effects of antioxidants, and similar subjects (presented at a SUNY Downstate program hospital's Internal Medicine department in 1988). One advantage of having such a longstanding interest preceding scientific medical study is that it becomes far easier to spot the “snake oil peddlers” once you learn how things really work. My practice is to follow the best standards and hold to proven medical practices. Many alternatives are considered, but are relegated to safe, adjunctive roles when not contraindicated.

Later on, I worked as a paramedic, a physician and student physician in Emergency, Intensive Care, and Cardiac Care units. I felt extremely rewarded knowing without doubt that I helped save many lives in those critical care environments. It is my belief that the impact of a good psychiatrist on people's lives may appear to be less immediately obvious or dramatic, but I believe that it is certainly no less important to those people who are relieved from very significant suffering from illnesses treated by psychiatrists.

Medical school courses require a command of certain basic sciences before one may even register for the courses. It really isn’t possible to understand beyond a very superficial and sketchy level even the first, introductory Medical School courses without having completed comprehensive study in chemistry, biology, physics, and math. The very first pharmacology course requires a solid command of several years of inorganic and organic chemistry, physiology, biological systems, biochemistry and the academic discipline to learn those difficult subjects. Pharmacology is integrated into the training on a regular, intensive basis for most of the following eight years of a psychiatrists’ formal education after college.

During medical school I was lucky enough to arrange to do a special psychiatry “rotation”. I had the unique experience of being, at that time the only student/doctor/trainee etc. to actually live in the venerable Manhattan Psychiatric Institute while undergoing training. MPI is one of the oldest and largest institutions in the U.S. It is located on its own, large island offshore in Manhattan, NY. During the approximately half year I was there, I lived with, ate in the cafeteria with, strolled the grounds, socialized, etc, with the many patients who were in residence there. During the day I was working in the wards under the supervision of my teachers (professors of psychiatry and psychology on the staff of MPI). Because I was there “24/7” my time with the patients extended well beyond the usual, expected 40-50 hours per week of clinical training. I felt very fortunate, indeed to have this early experience well in advance of my psychiatry residency training. That was an elective that I was able to modify to maximize the experience, but all medical students have additional requirements for classroom courses in Behavioral Science regardless of their intended future specialization.

I had heard that the medical training in England was somewhat different than in the U.S. in that the students had much more individual didactic contact with senior doctors, and more practice with patients, (and less “scut” work). Having learned this, I had the good fortune to arrange to study Medicine and Surgery at the Royal Hampshire Hospital in Winchester England. The Royal Hants is a venerable old institutions with several medical school affiliations, and was, during my time in training there, visited by Queen Elizabeth, who came to meet us as part of the celebration of the 275th birthday of the hospital.

Many people are unaware that Psychiatrists are licensed to practice general medicine. We are required to continue with general medical training even after getting an M.D. Most psychiatrists incorporate that training as part of their psychiatry residency. I chose to do a separate, Internal Medicine internship in a big city hospital to challenge and enhance my skills as a medical doctor. Many people find the official work schedule of a medical intern to be surprising. My schedule involved a 12-16 hour day every day, except for every third day, when I was required to work the entire day and night, and the subsequent, regular (12 hour) shift the next day. That is, for example: Monday 12 hours, Tuesday 14 hours, Wednesday 24 hours, Thursday 12 hours, Friday 14 hours, Saturday 24 hours, and Sunday 12 hours, and one Sunday off a month! Yes, really! Yes, that does add up to 110 hours per week (and doesn’t count all the studying).

The time in internship and residency is not all patient care. There are classroom didactics, independent study required, conferences, and rounds. Doctors (M.D.’s) are required to take national, standardized tests for the first two years of medical school, the first four years of medical school, and the first 5 years of medical school/residency. We cannot be licensed without passing those (one to two day long) exams.

I began my formal, postdoctoral study of psychiatry at the University of Miami School of Medicine. One special aspect of that residency program is the vast and broad population served. There are strong cross-cultural challenges, and there is more exposure to more pathology and to more rare pathology (being essentially a medical destination for large numbers of foreign visitors). While there, as my class representative, I introduced a system whereby the patients could be fully covered by the residents without the residents having to stay up all night every third night—making things better and safer for all.

One area of interest that I was able to expand upon was that of addictions. I was privileged to be one of a small team helping get the new addiction center going under the direction of Dr. Barbara Mason. Our first scientific study was a fascinating look at a brand new drug that prevented the brain from reinforcing drinking patterns by blocking endorphins…that is, we took the “buzz” out of drinking. That approach continues to be one avenue of approach to addictions today. I followed my interest in addiction further and undertook a number of elective rotations at the excellent Veterans Hospital there to learn more about addictions and traumatic stress. I've been working with people facing difficulties with substances throughout my psychiatric career.

I transferred to the Chapel Hill School of Medicine, Department of Psychiatry to finish my four years of postdoctoral training in psychiatry. It was there that I discovered during fairly extensive training in forensics during my residency that there were some very prominent Forensic Psychiatrists on the faculty. I had the good fortune to become the First Fellow in Forensic Psychiatry at Chapel Hill in my fifth postdoctoral year of training. The significance of formal forensic training, as it relates to clinical patients, is the emphasis on diagnostics. Formally trained forensic psychiatrists are actually diagnostic sub-specialists.

A common misperception has been emerging lately: the idea that psychiatrists are prescription writers and aren’t involved with psychotherapy or extensive diagnostics. The reality is that psychiatrists have far more supervised clinical training in psychotherapy than any other profession. A psychiatrist is required if a diagnosis is complex and requires the integration of diverse diagnostic modalities or more serious mental disorders. Sadly, this trend has devolved in part due to financial considerations, a shortage of qualified psychiatrists, and insurance pressures, hence limiting patients' access to optimal psychiatric services.

My forensic work has taken me down some unusual and interesting roads. I’ve been enlisted to evaluate mass and multiple murderers, and an alleged American “Terrorist”, I’ve interviewed more than a hundred murderers and hundreds of violent felons. I’ve been on a number of committees involved with management of the criminally insane, public safety issues related to the mentally ill, advisory committees, a national congressional advisory committee, etc. Despite all the drama associated with forensic cases, my first professional interest is, and will remain, working with individual patients—which is the center and focus of my practice.

My patients tell me that many considering seeing a psychiatrist like to have a better idea of who and what a psychiatrist is when making that very tough decision to find help. I hope that I have anticipated and addressed some of your questions.



Dr. Welch

Personal Note

Location & Directions

Contact Us

The Office



Bruce Welch, M.D.
535 Central Ave.
St. Petersburg, FL


Copyright © 2008   Bruce Welch, M.D.   All Rights Reserved.         Terms and Conditions       Privacy Policy