another psychology or psychiatry thread... w/ twist

I would love some advice on a dilemma I have been chewing over from various angles for a year. I am officially stuck.

I am trying to decide, while working full time, how best to leverage the time between now and the next admissions cycle by taking classes.

The choices are psychology (the PhD) and going straight for the MD in psychiatry. Other programs I have looked at involve speech language pathology and occupational therapy. I have a 3.8 in a non-psych subject from an Ivy, 170 on the GRE, and two non-psych pubs. Not exactly tailored to anything right now.

Applied to 4 Phd programs in my city last cycle- 3 rejected, 1 waitlist then rejected.

What I want: to work with both adults and kids (I have more experience and confidence with kids). Particularly communication and speech difficulties. I am extremely passionate about the idea of doing psychotherapy but will not know where this will take me 10, 15 years down the road. People say it is wise to branch out, and I know I am good with kids, having volunteered/taught kids with learning disabilities.

HOWEVER! I want a kid of my own. My boyfriend is currently encouraging me to try child psychiatry.
I am worried that being a psychiatrist will a) not leave time for a family and b) require a late start for my family. I am 26= 1 post bac year +4 med + 4 residency +1 child fellowship.

Psych residencies in this area purportedly have some VERY family friendly programs but the idea of definitely poppin' one out M4 or 2nd year of residency is scarily definite for me right now. I know I want a family.

I am also not primarily a believer in meds. I love the idea of doing therapy with childen.

The money is not important. Being somewhat in control, autonomous, and secure enough to have a family + middle class existence is.

So- overall, any recommendations? !

P.S. What is the job market like for Phds with a speciality in childhood social skills/language difficulty and communication? What kind of a salary can I aspire to there?

Sorry I know this is a tall order!!!! Any feedback would be much appreciated, as the questions are just whirling around in my head, and I know it's time to jump in.

I'm not intending to further confuse you, but your clinical interests seem to indicate you'd enjoy behavioral neurology more than psychiatry.

Just a thought.

I'm a psychiatrist that usually doesn't come to this side of the forums. Mind you that I have a bachelor's in psychology and almost went into the field. I too struggled to decide on which one.

Ultimately, and it was not as informed a decision as I have now with many more years of experience I chose psychiatry because I figured if I couldn't decide which one I would've liked better so I choose the one with better money and more job security. (Of course I know now that's not always true with psychiatry vs. psychology).

The biggest drawback with going into psychiatry if you love the behavioral sciences is so much of medical school is not based on mental health but the pure physical. While some people may say this is simply an obstacle, it's an obstacle to the degree where it's not like jumping over a hurdle but climbing over a mountain. By the time you get to the other side you're likely going to be a very different person. It's easy to deal with delayed-gratification on the order of hours, weeks or even months. When it comes to years, now that's a different thing.

Personally I hated medical school and found memorizing things like the little doo-hickeys (I don't remember what they're called now) that anchor a hair follicle into the skin irrelevant since I knew I wanted psychiatry from the start. I also had to tolerate years of several medical doctors telling me not to go into psychiatry based on their own narcissistic and closed-minded viewpoints that their field was the best.

My advice is weigh the following factors: what would you like more? Being a physician, trained in the medical science (including cutting up flesh, sticking fingers up anuses, drawing blood), specialized in treating mental illness or a seeker of the human mind in general with more of a mathematical/experimental training foundation? Think about the quality of life while as a student in either field. The work hours in medical training are horrendous and to the degree where it's going to be like being drafted into the military but highly structured, while psychology graduate school can be stressful in a very different way because you're likely going to have to come up with new material. I know several that can do one but not the other.

Also factor in what profession is more to your liking once you finish your training including the day-to-day activities, lifestyle, and the pay.

I am worried that being a psychiatrist will a) not leave time for a family and b) require a late start for my family. I am 26= 1 post bac year +4 med + 4 residency +1 child fellowship.

Your worries are valid. It's not easy being in a relationship if youi're in medschool or residency unless your partner is willing to support you. I've known several women who quit medschool because they didn't believe they could have a family while being a medstudent. I've mentioned before in the psychiatry forum-in a sense it's actually quite sexist. Most women entering medschool are in the mid-20s, and by the time they graduate from a residency in their mid-30s. Most medschools and residencies have little tolerance for allowing women to take time off to have and raise kids. I recall being on call during my internal medicine rotation and a colleague of mine in internal medicine was working a 24 hour shift while her 4 year old daughter was in the call room while coloring some pictures. She was on the medical floors about 20 hours while on call and had to ask the other residents while in the call room to keep tabs on the kid. During the little free time I had, I sat with the kid. Another woman I knew was pregnant, was incontinent but made to come back to work by the program director because she used up her maximum maternity leave time and had to wear a Depends diaper because she was not going to be excused.

There are several people in my clinical psych Ph.D. who've had children while in the program or on internship. It can be stressful to juggle it all but it sounds like a proper vacation compared to what whopper described. I think Ph.D. programs are more varied as far as culture goes compared to the medical education track. Definitely feel out the programs and ask to talk to grad students who have families.

If you want to do behavioral work and you don't care about salary then in my opinion medical school should be thrown out the window. Your interests actually seem more lined up with Speech/Language Pathology--and you could be practicing after a 2 year masters (3 if you have no undergrad coursework in this area). I believe in all 3 fields you do end up having to choose between adult/children.

Btw, I don't recall Sidney Friedman prescribing any meds. Did he? :

edit: Tho its not really a fair question I guess cause it was set in the late 50s

Originally Posted by Poetic Silence

I'm not intending to further confuse you, but your clinical interests seem to indicate you'd enjoy behavioral neurology more than psychiatry.

Just a thought.

How interesting- I had to go look up this thread to understand what you meant: http://forums.studentdoctor.net/showthread.php?t=275775. Thanks for that suggestion!!!

Originally Posted by whopper

...While some people may say this is simply an obstacle, it's an obstacle to the degree where it's not like jumping over a hurdle but climbing over a mountain. By the time you get to the other side you're likely going to be a very different person.....

I've mentioned before in the psychiatry forum-in a sense it's actually quite sexist. Most women entering medschool are in the mid-20s, and by the time they graduate from a residency in their mid-30s.

Yes, it's like the army! Or volunteering to go into space. Imagine being 100K+ in debt and discovering one can not have children anymore, or must have them NOW, or else.

Memorizing facts comes really easily to me. I daydreamed in my last job, which required a lot of stressful, not that open ended "finding the 'right' answer" style research, about having nothing to do but memorize. It's more the lack of a support system in medical training that strikes me as difficult, as I can imagine the stress that would add to making personal decisions (like starting a family). I mean other than informal support like residents babysitting

I am devoted to my job right now but I can not imagine having to consider my coworkers' reactions to choosing to breed and factor them into the decision.

Anyhow thanks for this great answer. Now I'm curious to know if the culture varies from residency to residency, as roubs pointed out is true for PhD programs below.

Originally Posted by roubs

I think Ph.D. programs are more varied as far as culture goes compared to the medical education track.

From the perspective of starting a family or the culture in general?

Originally Posted by roubs

Your interests actually seem more lined up with Speech/Language Pathology--and you could be practicing after a 2 year masters (3 if you have no undergrad coursework in this area).

Absolutely-- yet my ultimate goal is being my own boss and I'm not sure Speech Language Pathology is a secure enough path to that for me. I will have no financial support during or after school. And, well, at 1/2 the cost of med school....

FYI according to the spreadsheet I made for two arbitrary Phd/ MD tracks, the MD only starts outstripping the Phd 6 years after the completion of training. That's the straight Phd, no neuropsych training or other specializing. For those who know in advance they will finish and have a clear preference for medical study, psychiatry is probably better financially. (No surprise there).

If you like working with neurobehavioral problems of children (e.g. autism spectrum, learning disabilities, tourette and tics, dyslexia, some focal epilepsies, ADHD etc.) you could enjoy a

1) "pediatric neuropsychology" 2-year fellowship after completing a 4/5-year doctorate (PsyD, or PhD) in general clinical psychology. This usually involves psychometric evalutation and rehabilitation of cognitive functions (attention, perception, memory, thinking, mentalizing, language, writing, arithmetic, emotions etc.) in children with neurodevelopmental disorders (as stated before, autism, dyslexia and learning disabilities, Down syndrome, TBI etc,.).

http://en.wikipedia.org/wiki/Pediatric_neuropsychology

2) "neurodevelopmental disabilities/pediatric neurology" (6-year combined) residency after an MD which involves 2-years of general pediatrics and 4-year combined program in pediatric neurology and neurodevelopmental disabilities (e.g. diagnosing and treating pediatric patients with learning disabilities, developmental motor, speech, language problems, autism spectrum, epilepsy etc.)

http://www.abpn.com/cert_ndd.html


For more typical "mental-health" problems like severe emotional and behavioral problems (like some cases labeled as "ADHD", Conduct disorder/oppositional defiant disorder, childhood depression and anxiety, child and adolescent psychosis, drug-abuse etc.) you would rather enjoy child and adolescent psychiatry (2-year fellowship after a general psychiatry residency) or clinical psychology focused on children and adolescents (also 2-year fellowship after a general clinical psychology PhD or PsyD).

Another pathway from the MD-route which is similar to child and adolescent psychiatry (and neurodevelopmental disabilities as well) is "developmental/behavioral pediatrics" which is a 3-year training in general pediatrics followed by 3-year fellowship in developmental/behavioral pediatrics.


I have done this research myself ( i was also interested in similar stuff) so hope i helped. It seems that there are many (unfortunately a bit long!) pathways leading to these patient-groups so choose one that suits you and enjoy!

A lot of your interest are also a big part applied behavior analysis. You could achieve certification at the masters level (and, depending on where you are, not have too much trouble finding a job that meets your personal needs), with an increasing number of options to go on and get the Ph.D.. The main journal in the field- Journal of Applied Behavior Analysis- is online, with a search engine on its website and all issues available via pubmed central. I'd suggest taking a look at some of the research done in this field. If it fits into what you're interested in, in might be a great option.

I'm going to say something that is egocentric, and possibly ignorant and I invite my psychological colleagues to correct me.

Medschool, in short, is 4 years of taking in inhuman amounts of data (about 25 credits per term and all of them are hard credits. College is about 15 credits per term but about 1/3 the credits are hard, 1/3 are medium, 1/3 easy-medschool they're all hard), and then having to spit out the data in the form of answering multiple choice tests. You're expected to swallow in huge volumes of data, then over a very mind-crushing 1-2 weeks just be in exams all day long and take tests.

I remember during exam week having to pull an all-nighter before an exam, after the exam having 48 hours till the next exam and requiring sleeping pills to make me fall asleep because I couldn't fall asleep thanks to all the caffeine that kept me up the night before, then waking up and drinking in about 20 cups of coffee till the next exam, then taking sleeping pills again.....

Now as bad as that is, psychology grad school is a different type of stress because you likely will have to come up with something new. Think of John Nash from A Beautiful Mind. The hours might not be as tough (though they are still tough), but your actually going to really have to use your brain in a creative manner vs. being reduced to human encyclopedia.

Personally I find the latter more appealing if you're actually passionate about what you're doing. It could be hell if you don't like it. And as I said before, as difficult as medschool is, I know people in it who could not do psychology grad school because they were pretty much data-robots. They could take in obscene amounts of data and spit it out but could not think of how to push the existing bounds of knowledge.

I had a conversation with one of my mentors, ranked one of the top 100 medical doctors in the country and we discussed how we both truly hated medical school. I think I hated it because I really was an artist by training who after years of being determined to go into art just absolutely fell in love with the behavioral sciences. My mind was not wired to be a living computer. I think he hated it because he really is a scientist and a critical thinker and wanted to push the field forward. That type of thinking is not what medical school is about.

Now when you get passed all the schooling and residency, yes you could push the field forward, but by then your mind has been hammered and reshaped into a data-taker-in-then-spitter-outter.

Occasionally this discussion goes on in the psychiatry thread, and I've made comments that I feel psychologists can have more of a life even in grad school despite how difficult it is. Some interpreted that as a criticism. No way. The fact that (at least IMHO) the training is more balanced on the human mind and not based on simply giving out multiple choice tests on inhuman amounts of material, while allowing students to incorporate more creative reasoning IMHO is something that makes psychology graduate training better than medical training.

The biggest thing that ticked me off with medical school is that it wasn't so difficult because it was good education or difficult in a manner by design to make us better. It usually was so difficult because classes were often taught by A-hole professors that didn't give a damn about teaching and were bringing in mad money to the institution through research and it was difficult because the a-hole didn't spend the proper time teaching and making sure the exams were well designed. There were times the mean exam scores were on the order of 35% (with multiple choice question choices A-D), highly suggesting the exam didn't even validly gauge our real knowledge of the material.

whopper, what you've said mirrors pretty much every comparison I've heard made between med school and psych graduate school, so if your post isn't entirely accurate, it seems to be pretty darn close, and is in good company. The one main caveat might be that (and this is said from my standpoint of never having attended med school) there's significantly more variability in the intensity and quality of psych grad school training when compared to med school.

We definitely have instructors who care much more about teaching than others, but as a whole, most professors view course work as almost a formality. This doesn't mean that no faculty take classes seriously, but there's a reason the saying "B = Ph.D." is so ubiquitous; there's a definite importance hierarchy with respect to grad school responsibilities, and when it comes down to it, classes are at or near the bottom. The vast majority of your learning is expected to occur outside of class, and even more than that (because we could argue that the majority of learning in any type of program occurs outside class), to occur in pursuing activities entirely unrelated to class.

All in all, as you've said, the grad school process seems to place a stronger emphasis on critically creative/creatively critical thinking and responding rather than massive information consumption. Grad school training, as a whole, also seems to be significantly less-structured than med school. You've done a great job of listing the upsides of this setup. The downsides are that there's really no one looking over your shoulder to be SURE you're learning what you're supposed to learn and doing what you're supposed to do. I'd imagine the "bare minimum" in med school is still a helluvalot of work resulting in attaining a helluvalot of knowledge; conversely, skating by with the bare minimum in grad school could result in someone graduating a program (or at least entering internship) being woefully unprepared for either/both independent clinical practice or/and independent scholarly activity, with a significant amount of variability across programs and advisors as well.

On a more "quasi-philosophical" level, I can't speak to med school and its general atmosphere, but clinical psych grad school training almost universally seems to have an "it depends" mentality with respect to answering questions. You essentially continually hear that there are few clear, black-and-white answers to much of anything, and if there are, you're expected to go out and hunt them down for yourself. Thus, if you're not ok existing in a perpetual state of ambiguity and uncertainty, grad school could be a highly unpleasant experience.

Realistically, with either the PhD or MD route, it will be hard to start a family until your early to mid 30's. It can be done earlier with either route, but it will be a struggle Both my psychologist and physician friends are finally able to start getting pregnant and we are all early to mid 30s.

I suspect that there is real variability among PhD programs. My program was interested in training hard core researchers and they treated us terribly. There was no understanding for personal or family issues, even when very reasonable. Also, in our program there were clear favorites and "whipping-boys.". If you had the right advisor and they liked you, your experience was much better. I suspect that there is less of this with medical school, where your progression through school depends more on objective measures of success.

Also, it is worth thinking about the financial piece a little. I know you said that the money isnt important, but in the same sentence you said that you want a comfortable middle class existence. I wouldn't take for granted that you'll be able to have a comfortable middle class existence with a PhD. I am very displeased with my earning power as a psychologist, and I didn't think I would be. I feel that I am not going to be able to provide for my kids as well as I would have had I been a psychiatrist. It really bothers me that insurance companies reimburse psychiatrists at a rate triple the rate that they reimburse me. Of course a lot depends on how much income your husband brings to the table. If he makes enough, your salary might be less important.

Also, do you want to work full or part time? As a psychologist this is pretty easy to do this. I don't know about psychiatrists. I know that in some medical specialties, part time is 40 hrs per week!

Take this with a grain of salt, I am a psychologist who really wishes she had gone to med school instead! You might also be interested in the recent "would you do it again" thread.

Best,
Dr. E

Whopper-- again, what an amazingly invaluable answer! Thank you so much!

Acronym Allergy-- The ambiguity you stressed here is a really valuable point taken-- maybe that anxiety is inherent in any kind of creative work-- say, a novel project, or a painting. Grad students on here definitely talk about how their advising plays a big part in how that anxiety plays out-- aka how much pressure to produce and publish.

Dr. Eliza- Thank you for that candid assessment. I'm so so sorry you've had such a bad experience, what a nightmare! Whipping boys-- that sounds just terrible! But is a middle class existence out the window?--(Are we really talking figures like 35K for raising kids on?)

To sum up both paths then, in a sort of negative light: medical school is more facts and figures, perceived as merit based, more hardcore, and more cruel-- grad school more nebulously creative, intellectual, and nepotistic and also cruel. These are the stereotypes-- does this mean they pretty much hold up? Any happy stories about the education involved in becoming a psychologist/psychiatrist?

I've certainly enjoyed my time in grad school and internship, and am looking forward to fellowship, but as you mentioned in your post, this can greatly depend on advisor. Mine was awesome (as have been my supervisors thus far on internship), and so my grad school experience was equally-awesome.

In terms of pay, I'm of course not a practicing psychologist, so I can only quote figures--I believe the median income for psychologists is $65k, with a good bit of variability (e.g., some people will start close to $100k after licensure, and others will start in the $40k range). The advantage vs. a physician's salary, as you mentioned, is the potential to make it through grad school with little or no debt, which is difficult to do with med school (unless you're in a physician-scientist track, go military, etc.). Thus, as you mentioned earlier, it takes a few years for the true earnings differences to equalize and for psychologists to then be surpassed.

Originally Posted by printscreen

Dr. Eliza- Thank you for that candid assessment. I'm so so sorry you've had such a bad experience, what a nightmare! Whipping boys-- that sounds just terrible! But is a middle class existence out the window?--(Are we really talking figures like 35K for raising kids on?)

Wait . . . $35k isn't considered middle class? I apparently need to readjust my thinking.

Any happy stories about the education involved in becoming a psychologist/psychiatrist?

Er, the happiest students I know have been the ones who left. Admittedly, I do know students who were not particularly pleased while here but felt much better about the whole grad school experience once they left for internship.

Originally Posted by printscreen

Any happy stories about the education involved in becoming a psychologist/psychiatrist?

Yes, I'm happy with my experience in a balanced clinical PhD program. The "Would You Do it Again?" thread is populated heavily by people who answer this question with "no." Posters on that thread make good points about the state of the field, and I can see why they answer that way. Posters on this thread have also accurately portrayed the type of stress you are likely to experience in grad school. (Although no one has touched on the stress of applying to internships/residency, which is its own unique brand of anxiety .) All that being said, I am happy with the way most things have turned out. My faculty and classmates have been very supportive, and the amount I've learned throughout training makes it worth it to me. I hope that feeling continues as I finish everything up and move on to a career. I don't think I'm being naive, as I am pretty well educated about the state of the job hunt. I suppose we'll see.