Masters in Mental Health Counseling before MD/Psychiatry?

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Hi all,

I'm new to the SDN forum.

Was just wondering-- I am considering doing a full-calendar year master's program in mental health counseling (would get a M.S.Ed, but not a license unless if I do a second year) before applying to medical school. If I were to enter medical school, I would like to be a psychiatrist. I would enter in September of 2012, finish in August of 2013, while applying to medical school beginning June of 2012 for 2013 matriculation.

Am wondering if anyone has done that before (and if there are any known drawbacks)? What are people's thoughts on doing a masters (in a non-science field) before going to medical school?

A bit about myself- I am really interested in psychiatry, and would probably pursue that if I were to do medical school. Would definitely go the MD route, instead of the MD/PhD route. Have already taken the MCATs (32R) and have an okay-GPA from a double-major engineering degree (3.68c, 3.72s). Have a decent amount of experience volunteer/clinical/research-wise. Am taking two years off after undergrad-- my first year is currently working as a research tech at a children's hospital. If I were to do the masters program for my second year off, I would be ending my research tech position a year early (and eliminating the chance of a publication). I would really want this M.S.Ed because i'm really interested in counseling (have always been), and in some ways I am still deciding if I would want to go down a counseling or psychiatry career path. If I were to be a doctor/psychiatrist, I think knowing counseling skills would be really good skills to have. I hear psychiatrists are being trained more for the science/prescribing-medicine aspect during residency etc, and less for the human/relating to patients/compassionate-side. And, a minor reason, I think it'd be an interesting/unique addition to the med school application.

I have a few questions-- There seem to be a lot of med students/psychiatry residents floating around in this thread. Was wondering-- have any of you considered grad school for counseling instead of med school? And if so, why did you choose psychiatry over counseling? What are the pros and cons of psychiatry versus counseling? Also, are psychiatrists trained to be good therapists in medical school (I'm interested in doing therapy, regardless of whatever degree i end up getting)? Would you recommend getting a degree in counseling before getting a degree in psychiatry?

If I were to do the masters program, i'd probably end up with about 20-30K in loans.

Anyone willing to offer up thoughts/opinions/ advice?

Thaaanks so much!

More advantageous to do it the other way around.

Could you explain your reasoning for that?

Thanks

Well I am biased but I think the counseling industry has created a supply that far outstrips demands. Whilst I certainly believe in the restorative and healing power of talking to a trusted confidante, there isn't any good evidence supporting counseling as being any better than no intervention at all, although it is associated with high levels of satisfaction, and many people will say they were helped by counselors and they found counseling useful, it doesn't seem to make a difference to your longterm psychological wellbeing whether you saw a counselor or not. There is something slightly pernicious about the whole counseling industry (all the money is in teaching it), and the most frightening aspect is that counselors don't seem to appreciate that you can do a lot of harm, no matter how well intentioned you may have been. The counselling industry have attempted to undermine the already tenuous institutions that would usually provide support to the disaffected or an ear to our psychic woes and have rewritten a cultural script of vulnerability rather than resilience. We are no longer stoic, but repressed, or in denial; when a bad even happens we must have been 'traumatized' by it; it is as if they cannot imagine that people can experience adversity and emerge unscathed. For depression, the evidence for befriending (using unpaid volunteers) seems to be more robust than the evidence supporting counseling. There are also problems with what we mean by 'counseling' - for many people it is wedded to the humanistic tradition spearheaded by Carl Rogers and characterized by genuineness, empathy, unconditional positive regard, and acceptance. For others it is a watered down version of poorly understood psychodynamics, watered down existentialism, cognitive and behavior therapy practiced by the ill-experienced, or an 'eclectic' rag bag of ideas.

Psychiatry of course is also guilty of creating for a demand for its services by jumping into bed with pharma and manufacturing all sorts of new 'disorders' that seek to medicalize everyday life. That said, there are many, many people with severe mental distress who are crying out for psychiatric help but there are still many parts of the country where such help is unavailable, and primary care is the inexperienced and relunctant de facto mental health system in this country. You are right, psychiatrists tend to primarily prescribe drugs, and there is a tendency to prescribe 'because that's what we do' even if it isn't necessary, which is true of medicine in general in this country with its fee for service model. But psychiatrists are also able to tease out those who have a primary neurological, endocrinological, or otherwise somatic process that might appear to be 'depression' or 'anxiety' to someone not medically trained; they are able to recognise the effects of drugs and alcohol on mental states and attempt to treat both contemporaneously; they are able to make diagnoses of schizophrenia or bipolar disorder and prescribe appropriate treatment; they are able to help evaluate tricky ethical dilemmas where a patient may be refusing treatment, or assess mental capacity; they are able to provide an opinion regarding issues of mental health and the law for the courts or other institutions; they are able to consider the complex interplay of the biological, psychological, sociocultural, interpersonal, and spiritual (though mostly the first two) in a way that most other mental health professionals can't.

Medical school isn't for everyone and if you are not interested in learning the intricacies of the body and mind in health; spend gruelling months in the operating room, delivering babies, diagnosing the medically ill, becoming competent using a stethoscope and a tendon hammer, or have a bit of your soul and humanity eroded then medicine might not be for you.

However I would urge you to consider doing something a bit more useful than counseling. That is just my opinion and I'm sure others will disagree but I usually steer people away from this route. I also find it quite concerning that many in the counseling field (I won't call it a profession - it's not) seem to have levels of psychopathology far greater than that in the clients they are working with.

Time is money. Not to say that you won't learn good things in the masters, but if therapy is your thing there are plenty of residencies and fellowships that can train you in that. If you were set on your additional training be through a masters, then being able to do it while you work part time as a psychiatrist makes more sense than doing it now working part time as something else or not working at all. My guess, however, is that you'd probably be like eveyone else and just do residency and pursue further education in other ways.

You've got everything in hand to get in to medical school now. I don't know what your personal goals are, but if it were me I'd get that show on the road.

Hm. That makes a lot of sense, st2205 and splik. Thanks for the advice.

Could you tell me a bit about counseling versus psychiatry? A reason why I'd want to do this degree is partly because it would be good training for therapy (though your point about learning it in residency makes sense).

However, I would mostly be looking into the counseling program to figure out whether i want to be a counselor or not (and thus, if not a counselor, then to go down the med school path). Any suggestions on how to do this without getting in crazy amounts of debt? I've shadowed a psychiatrist attending and other medical residents before, but it wasn't too helpful...

Originally Posted by wskhunky

Hm. That makes a lot of sense, st2205 and splik. Thanks for the advice.

Could you tell me a bit about counseling versus psychiatry? A reason why I'd want to do this degree is partly because it would be good training for therapy (though your point about learning it in residency makes sense).

However, I would mostly be looking into the counseling program to figure out whether i want to be a counselor or not (and thus, if not a counselor, then to go down the med school path). Any suggestions on how to do this without getting in crazy amounts of debt? I've shadowed a psychiatrist attending and other medical residents before, but it wasn't too helpful...

While you may not incur as much debt with a masters you're also not very likely to find a decent job nor will you be able to make a decent living. There are many MSWs and masters level psychologists out there. I'm not sure what reimbursement from insurance is with mental health counselors. These are two very different fields. Is your interest counseling people or diagnosing and treating mental illness in a much sicker population?

And to piggy back on what I said, you'd learn therapy on sicker patients that would probably be more beneficial afterward rather than learning it on relatively healthy people and transitioning to sicker populations if you later went into medicine.

A lot of therapy training programs (those for after residency) are part-time or workshop based, and meant to be taught while you have a day job. It's nice to enhance your skills while already making 180+k in your day job.

Originally Posted by st2205

While you may not incur as much debt with a masters you're also not very likely to find a decent job nor will you be able to make a decent living. There are many MSWs and masters level psychologists out there. I'm not sure what reimbursement from insurance is with mental health counselors. These are two very different fields. Is your interest counseling people or diagnosing and treating mental illness in a much sicker population?

There is no such thing as a Masters level psychologist, except for maybe school psychologists in some states. You need a PhD or PsyD.

Originally Posted by splik

Well I am biased but I think the counseling industry has created a supply that far outstrips demands. Whilst I certainly believe in the restorative and healing power of talking to a trusted confidante, there isn't any good evidence supporting counseling as being any better than no intervention at all, although it is associated with high levels of satisfaction, and many people will say they were helped by counselors and they found counseling useful, it doesn't seem to make a difference to your longterm psychological wellbeing whether you saw a counselor or not. There is something slightly pernicious about the whole counseling industry (all the money is in teaching it), and the most frightening aspect is that counselors don't seem to appreciate that you can do a lot of harm, no matter how well intentioned you may have been. The counselling industry have attempted to undermine the already tenuous institutions that would usually provide support to the disaffected or an ear to our psychic woes and have rewritten a cultural script of vulnerability rather than resilience. We are no longer stoic, but repressed, or in denial; when a bad even happens we must have been 'traumatized' by it; it is as if they cannot imagine that people can experience adversity and emerge unscathed. For depression, the evidence for befriending (using unpaid volunteers) seems to be more robust than the evidence supporting counseling. There are also problems with what we mean by 'counseling' - for many people it is wedded to the humanistic tradition spearheaded by Carl Rogers and characterized by genuineness, empathy, unconditional positive regard, and acceptance. For others it is a watered down version of poorly understood psychodynamics, watered down existentialism, cognitive and behavior therapy practiced by the ill-experienced, or an 'eclectic' rag bag of ideas.

Empirically-based therapies like CBT have a LOT of data supporting their use, at least as much as pharmacological treatments do. Research also shows that therapy and medication in conjunction can be even more effective in reducing symptoms and decreasing relapse rates than medication alone.

And, no, counseling doesn't assume that all people with trauma histories have problems. If they don't have problems, they don't come in and we don't diagnose them or give them treatment.

Originally Posted by cara susanna

There is no such thing as a Masters level psychologist, except for maybe school psychologists in some states. You need a PhD or PsyD.



Empirically-based therapies like CBT have a LOT of data supporting their use, at least as much as pharmacological treatments do. Research also shows that therapy and medication in conjunction can be even more effective in reducing symptoms and decreasing relapse rates than medication alone.

And, no, counseling doesn't assume that all people with trauma histories have problems. If they don't have problems, they don't come in and we don't diagnose them or give them treatment.

There was a good debate at the Institute of Psychiatry (Maudsley debates) a while back on is counseling harmful. Fun food for thought, particularly as to whether it fosters dependence.

http://www.iop.kcl.ac.uk/podcast/?id=193&type=item

A lot of these kinds of discussion really come down to the questions asked, and the data gathered. "Medications don't help" and "Supportive counseling doesn't help in the long run" are kind of blanket statements. The better idea would be to approach with the question of "for whom and when are these treatments helpful." Supportive counseling likely doesn't teach coping skills, but sometimes it does (modeling, similar to how borderlines were thought to burn out over time, turns out they're slowly acquiring better coping strategies from other, but it can take decades longer than other people if it happens). Furthermore some people don't need addiitonal skills permanently. They need support through a crisis.

Similarly, psychology students on SDN love to bash meds (except on the RxP forum where they magically think psychologists with 400 hours training are superior psychopharmacologists) often quoting the Kirsch meta-analysis, yet neglecting their extensive stats training which should have taught them the flaws of meta-analyses. A better question than if meds work is -- for whom do meds work, in what circumstances.

...Whom does the grail serve?

I don't think just having the degree would be worth much as far as getting medical school and residency apps- if your plan is to go immediately into medical school upon finishing the MEd. Now, getting the counseling degree, working for several years and using that degree/getting licensed, building your skills- THAT would be much more interesting/valuable to programs. It is a fair amount of lost income, though, if you already know that you want to go to medical school.

Originally Posted by st2205

While you may not incur as much debt with a masters you're also not very likely to find a decent job nor will you be able to make a decent living. There are many MSWs and masters level psychologists out there. I'm not sure what reimbursement from insurance is with mental health counselors. These are two very different fields. Is your interest counseling people or diagnosing and treating mental illness in a much sicker population?

Reimbursement is typically MD/DO >> PhD/PsyD >> LCSW= LMHC/LPC

Interestingly, Medicare is still not reimbursing LMHC/LPCs for psychotherapy despite years of lobbying by the counselors. Most private insurance companies will credential all of the above (plus APRNs).

Originally Posted by pingouin

I don't think just having the degree would be worth much as far as getting medical school and residency apps- if your plan is to go immediately into medical school upon finishing the MEd. Now, getting the counseling degree, working for several years and using that degree/getting licensed, building your skills- THAT would be much more interesting/valuable to programs. It is a fair amount of lost income, though, if you already know that you want to go to medical school.

Thanks for your reply-- I think I have good enough stats and volunteer/clinical experience to get into med school without a MSEd degree (*crosses fingers*). My main purpose in getting the degree would be to have experience doing counseling and therapy (can't shadow counselors, have pretty much no idea what it is like), and to get a gauge for whether that career would be satisfying for me or not. I think I would find it interesting to do therapy for the majority of my time, but i also love learning the sciences & new information. In other words, seeing if I could find enough satisfaction in being a counselor, doing therapy, without having to do med school. Not sure if i'm explaining myself clearly =T

Originally Posted by wskhunky

Thanks for your reply-- I think I have good enough stats and volunteer/clinical experience to get into med school without a MSEd degree (*crosses fingers*). My main purpose in getting the degree would be to have experience doing counseling and therapy (can't shadow counselors, have pretty much no idea what it is like), and to get a gauge for whether that career would be satisfying for me or not. I think I would find it interesting to do therapy for the majority of my time, but i also love learning the sciences & new information. In other words, seeing if I could find enough satisfaction in being a counselor, doing therapy, without having to do med school. Not sure if i'm explaining myself clearly =T

I think I understand what you're getting at, and I think your intentions are good. However, in another post you stated that the counseling practicum would be 224 hours. Are you aware that the MINIMUM requirement for an accredited MSW is 900 practicum hours? (CSWE requirements, section 2.1.3) So even compared to the MSW, the program you're looking at is significantly lacking in field experience, aka patient/client contact.

You also stated

Just wondering, though-- if I am still undecided between either profession, is it best to just get a master's first (would be +30K in debt, and miss out on a publication)? and if i like it, i could do the second year and pursue licensure, and if i don't, then go to med school?

Or would it be better to go to medical school, decide i actually (and with more certainty) want to do psychiatry/psychology-related work, and then pursue a masters/ do workshops to be able to focus on therapy & improve skills in thearpy, so i can do therapy+ med management?

What did you mean by the bolded section? Counseling programs are two years long. Typically the practicum hours are all done during the second year of the program. So saying "if I like it, I could do the second year" doesn't really make sense as the entire first year is primarily classroom work and would not get you the specific clinical experience you're talking about.

Finally, getting a license in counseling (typically called the LPC or LMHC) is a separate endeavor that takes at a minimum 2 years (if you're working full-time) that involves a national exam as well as weekly clinical supervision. So if your goal is licensure, you are literally talking a 4 year endeavor- by which time you could have completed medical school.

Originally Posted by cara susanna

There is no such thing as a Masters level psychologist, except for maybe school psychologists in some states. You need a PhD or PsyD.

That's an issue of semantics which is debatable.

Full membership to the AP(sychology)A does require a doctoral level degree. However, psychologists, as defined as "practitioners...who perform assessment, diagnosis, treatment, and prevention of mental disorders", do include licensed mental health counselors, or Licensed professional counselors (LPC) as they're called in different states, as well as Licensed Educational Psychologists (LEP). Masters degrees qualify for both. There's a myriad of other titles too, I just don't know them all.

To further close the gap, the average pay difference between masters vs doctoral is pretty meager. If doctoral-level psychologists are so different, then why don't they get paid more to reflect their additional skills?

http://www.apa.org/workforce/publica...ies/index.aspx

Here's one example: working at a university w 6-9 yrs training:
mean for dr $54k
mean for masters $45.5k

http://www.apa.org/workforce/publica.../table-14a.pdf
http://www.apa.org/workforce/publica...s/table-05.pdf

Originally Posted by pingouin

I think I understand what you're getting at, and I think your intentions are good. However, in another post you stated that the counseling practicum would be 224 hours. Are you aware that the MINIMUM requirement for an accredited MSW is 900 practicum hours? (CSWE requirements, section 2.1.3) So even compared to the MSW, the program you're looking at is significantly lacking in field experience, aka patient/client contact.

You also stated

What did you mean by the bolded section? Counseling programs are two years long. Typically the practicum hours are all done during the second year of the program. So saying "if I like it, I could do the second year" doesn't really make sense as the entire first year is primarily classroom work and would not get you the specific clinical experience you're talking about.

Finally, getting a license in counseling (typically called the LPC or LMHC) is a separate endeavor that takes at a minimum 2 years (if you're working full-time) that involves a national exam as well as weekly clinical supervision. So if your goal is licensure, you are literally talking a 4 year endeavor- by which time you could have completed medical school.

I'm considering doing the Upenn master's in mental health counseling program (MSEd). The nifty thing about their program is you can choose to do one year, or two (see website here: http://www.gse.upenn.edu/degrees_pro...unseling_psych). First year/track1 gets you a degree + 224hours, and the second year/track2 gets you actually licensure + 600+ hours of practicum experience.
My goal through doing this first year (Aug 2012-May 2013) is to decide, through that limited 224 hours, whether I would enjoy doing counseling for the rest of my life. If so, I'd continue onto the second year (Aug 2013-May 2014)to get licensure. If not, I'd continue my application-process with medical school and begin in Aug 2013.

Sorry for the confusion. Hope this clears things up a bit?

Originally Posted by pysch4sure

That's an issue of semantics which is debatable.

Full membership to the AP(sychology)A does require a doctoral level degree. However, psychologists, as defined as "practitioners...who perform assessment, diagnosis, treatment, and prevention of mental disorders", do include licensed mental health counselors, or Licensed professional counselors (LPC) as they're called in different states, as well as Licensed Educational Psychologists (LEP). Masters degrees qualify for both. There's a myriad of other titles too, I just don't know them all.

To further close the gap, the average pay difference between masters vs doctoral is pretty meager. If doctoral-level psychologists are so different, then why don't they get paid more to reflect their additional skills?

http://www.apa.org/workforce/publica...ies/index.aspx

Here's one example: working at a university w 6-9 yrs training:
mean for dr $54k
mean for masters $45.5k

http://www.apa.org/workforce/publica.../table-14a.pdf
http://www.apa.org/workforce/publica...s/table-05.pdf

Psychiatrists of all people should be sensitive to the issue people with less training encroaching on areas of expertise despite lack of evidence for them to do so. AFAIK the states that allow Masters-level clinicians to be called psychologists are few and far between, the only one I know of offhand is Kansas. We're not paid much more because most people outside of the field do not recognize the difference and because our political organization (APA) is not doing a good job of advocating for us.

As for how PhD/PsyD vs. Masters is different, you'll have to stop by the Clin Psych forum because that issue is constantly discussed there and discussing it here would definitely derail this thread. To provide a brief summary though, there are vast differences in research training and even clinical training. Furthermore, PhD/PsyD level people get much, much more training in assessment.

Originally Posted by nitemagi

There was a good debate at the Institute of Psychiatry (Maudsley debates) a while back on is counseling harmful. Fun food for thought, particularly as to whether it fosters dependence.

http://www.iop.kcl.ac.uk/podcast/?id=193&type=item

A lot of these kinds of discussion really come down to the questions asked, and the data gathered. "Medications don't help" and "Supportive counseling doesn't help in the long run" are kind of blanket statements. The better idea would be to approach with the question of "for whom and when are these treatments helpful." Supportive counseling likely doesn't teach coping skills, but sometimes it does (modeling, similar to how borderlines were thought to burn out over time, turns out they're slowly acquiring better coping strategies from other, but it can take decades longer than other people if it happens). Furthermore some people don't need addiitonal skills permanently. They need support through a crisis.

Similarly, psychology students on SDN love to bash meds (except on the RxP forum where they magically think psychologists with 400 hours training are superior psychopharmacologists) often quoting the Kirsch meta-analysis, yet neglecting their extensive stats training which should have taught them the flaws of meta-analyses. A better question than if meds work is -- for whom do meds work, in what circumstances.

...Whom does the grail serve?

Fair enough, it is a more nuanced question. I was just trying to say that counseling (well, certain techniques anyway) has as much evidence behind it as medication.

FWIW, I don't support RxP for psychologists.

Originally Posted by cara susanna

I was just trying to say that counseling (well, certain techniques anyway) has as much evidence behind it as medication.

For sake of this discussion, I we are emphasizing a difference between "counseling" and "psychotherapy." Psychotherapy has good evidence. Counseling doesn't.

To the OP, I think you're basically asking if you should take a year of ukelele lessons before you take 8 years of violin lessons. At the end of those 8 years, those ukelele lessons will have been a waste of your time. Now, if you wanted to take a few years for mandolin lessons before taking violin, that might have some value, but it's not really necessary (and if later you want to learn to play mandolin, it will take some work, but mostly just learning how to flatpick). If you start with mandolin and decide after 2-3 years you just want to play mandolin, then you're in your mid 20s and you haven't sacrificed the best years of your life away and you can live happily ever after. If really just depends on if you see yourself playing bluegrass or classical music or both. Plenty of classical violin players pick up fiddling later, though it does take some special training in itself.

Given this is one of my most wandering metaphors EVER, i will provide the key:
ukelele = counseling
violin = medical school/residency
mandolin = psychology/SW grad degree
bluegrass = psychotherapy
classical music = general psychiatry

Originally Posted by cara susanna

Fair enough, it is a more nuanced question. I was just trying to say that counseling (well, certain techniques anyway) has as much evidence behind it as medication.

FWIW, I don't support RxP for psychologists.

I know Cara. I've heard your voice on the RxP thread, and appreciate your balanced perspective.

To the OP, it seems to me the other elephant in the room (besides whether to go to medical school or not) is the assumption that you'll enjoy doing therapy having had little exposure to it.

I would suggest you talk with at least 3 graduates of the program you're looking at, and see what they're doing with it, their perspective on the program, pros/cons, and their thoughts on your situation.

Originally Posted by cara susanna

Psychiatrists of all people should be sensitive to the issue people with less training encroaching on areas of expertise despite lack of evidence for them to do so. AFAIK the states that allow Masters-level clinicians to be called psychologists are few and far between, the only one I know of offhand is Kansas.

Ditto this. It's ironic that while so many folks get absolutely outraged at the idea of mid-levels encroaching on psychiatric turf that folks can't differentiate between a master's-level therapist and a doctorate-level psychologist.

Originally Posted by billypilgrim37

For sake of this discussion, I we are emphasizing a difference between "counseling" and "psychotherapy." Psychotherapy has good evidence. Counseling doesn't.

Oh, well, I feel sheepish. Sorry, your mentioning CBT confused me. I'm not a big fan of supportive counseling, either (and I've done it, too).

To the OP (finally, I'm on-topic ): I agree that an MA in mental health counseling won't help you much. The issues brought up about supply exceeding demand are correct. You can get therapy training as a psychiatrist. Plus, you need to make sure that you like therapy before committing. I thought I'd love it and I absolutely do not.

Originally Posted by cara susanna

Psychiatrists of all people should be sensitive to the issue people with less training encroaching on areas of expertise despite lack of evidence for them to do so.

I work with doctoral midlevelers, DNPs and RxP psychologists, and have no problem with them.

Originally Posted by cara susanna

AFAIK the states that allow Masters-level clinicians to be called psychologists are few and far between, the only one I know of offhand is Kansas.

Actually, most states have master's level psychologists. The National Association of School Psychologists has a list of all approved schools that you can see here. You're hard pressed to find a single state that does not allow people with MAs to be called 'psychologists'.

Originally Posted by cara susanna

As for how PhD/PsyD vs. Masters is different, you'll have to stop by the Clin Psych forum because that issue is constantly discussed there

I know what the differences are, thank you though. There are many, and certainly doctoral-level trained clinical psychologists have better training. Obviously.

I do think the holier-than-thou attitude, your unwillingness to even acknowledge lesser psychologists, shows a great lack of respect for our colleagues. That's why I responded to your post. I work with master's level psychologists, and they're very good at what they do, hence why their pay rivals yours. I do not think belittling their title does any benefit for you or your field.

Originally Posted by cara susanna

We're not paid much more because most people outside of the field do not recognize the difference and because our political organization (APA) is not doing a good job of advocating for us.

If the APA is so deficient in its duties, how do you explain independent, RxP for psychologists? It takes a lot of political capital to convince lawmakers that human biology can be adequately summed up in two 'Biological Foundations' courses.

Originally Posted by pysch4sure

I work with doctoral midlevelers, DNPs and RxP psychologists, and have no problem with them.



Actually, most states have master's level psychologists. The National Association of School Psychologists has a list of all approved schools that you can see here. You're hard pressed to find a single state that does not allow people with MAs to be called 'psychologists'.



I know what the differences are, thank you though. There are many, and certainly doctoral-level trained clinical psychologists have better training. Obviously.

I do think the holier-than-thou attitude, your unwillingness to even acknowledge lesser psychologists, shows a great lack of respect for our colleagues. That's why I responded to your post. I work with master's level psychologists, and they're very good at what they do, hence why their pay rivals yours. I do not think belittling their title does any benefit for you or your field.



If the APA is so deficient in its duties, how do you explain independent, RxP for psychologists? It takes a lot of political capital to convince lawmakers that human biology can be adequately summed up in two 'Biological Foundations' courses.

Interesting perspective, though a little oppositional to doctoral psychologists. Everyone is worried about their own turf. Many MD's do feel threatened by DNP's, RxP's, for a variety of reasons (what we feel is inferior medical training for too broad a scope of practice). PhD's and PsyD's feel they have superior training to Master's level therapists, which they probably do. My personal opinion is there's less outcomes research as to safety, efficacy, and superiority of level of training for therapy, compared to safety data for medications (the Institute of Medicine has some pretty good data on medical errors amongst the undertrained, and RxP's and DNP's are far inferior in their amount of training relative to a resident).

I don't think this is at all relevant to the issue of salary, though. Our culture rewards certain things and not others. Should sports figures be making 8 or 9 figure salaries? Is that what we celebrate. In academia it isn't tied to amount of education, as PhD's (say in the humanities) make a pittance. Instead it comes down to reimbursement and money generated. Whoever set the fee schedule initially gave most to "procedures" namely surgeons, and then down from there. Cognitive interventions were reimbursed less. Those setting fee schedules have even less understanding as to the differences in practice related to training in psychotherapy (and researchers haven't done much to expand the evidence on differences either).

Originally Posted by nitemagi

I don't think this is at all relevant to the issue of salary, though. Our culture rewards certain things and not others. Should sports figures be making 8 or 9 figure salaries? Is that what we celebrate. In academia it isn't tied to amount of education, as PhD's (say in the humanities) make a pittance.

Fair enough Sir, I stand corrected. I don't think sports figures are necessarily relevant to this discussion, but your comment about pay in academia certainly proves a point. You are right.

I agree with everything else you said.

However, I do not think I'm 'oppositional' or hold hostile views towards doctoral level psychologists; in fact, as we can see in this discussion, it seems to be the other way around. Cara's view is typical of her cohort, namely that no-one else can consider themselves to be psychologists. In addition to being insulting to an entire group of professionals, it's also a little naive; no matter what you may feel or think about what should be, master's level psychologists exist, and they do a great job.

Also, I did make an error in my last post. I work with an NP who has a PhD in something unrelated to her job. I thought she was one of the psychologists with rx privileges, but she's not. Still, I don't really have a problem with midlevelers like i said.

I have nothing against midlevel providers. I also have worked with MA level therapists and have respect for them. I have no desire to provide therapy as a career, so good on them for doing it. However, there is no denying that doctoral level clinicians have more training, practicum experience, and research background. You're comparing 4 years (minimum) to 2, after all.

I acknowledged school psychologists earlier, they are the one exception to the "psychologist" rule, but their roles are also different from Masters-level therapists. If you were referring to only them I apologize, but usually when discussing therapy Masters-level providers refers to MSWs or MA in Counseling people.

As for my reaction, perhaps it was over the line, but imagine how you would feel if someone with half the years of training and school that you do started calling themselves a psychiatrist.

The APA's pushing RxP when a lot of us don't want it is exactly the issue I was describing because they are ignoring other issues that are far more important (like protecting our professional turf). But frankly, I don't even think they're doing a great job with RxP, it's only allowed in a few states and I doubt it will ever fully take off. APA is acting like RxP is a cure-all to our problems, so if it passes our field is completely saved. That's definitely not true IMO.

Originally Posted by cara susanna

However, there is no denying that doctoral level clinicians have more training, practicum experience, and research background. You're comparing 4 years (minimum) to 2, after all.

Right, I did not deny that, in fact I stated that quite clearly. 4 is more than 2, ok. That makes (or will make) you a better trained psychologist, but it doesn't mean that there aren't less trained psycholgists who also make an impact on people's lives. That's what I'm trying to get at.

Originally Posted by cara susanna

I acknowledged school psychologists earlier, they are the one exception to the "psychologist" rule

You acknowledged Kansas. To me that's belittling the impact of their profession, when there are actually thousands across almost every state.

Originally Posted by cara susanna

As for my reaction, perhaps it was over the line, but imagine how you would feel if someone with half the years of training and school that you do started calling themselves a psychiatrist.

I am told all the time that psychiatrists aren't really physicians, sometimes from other doctors too. I know two attendings who introduce themselves in public as being 'physicians' instead of a 'psychiatrists' in order to avoid the long explanation that they went to medical school, etc. I assure you, there's not an overabundance of prestige in psychiatry, at least in my limited experience.

In terms of the use of 'psychiatrist' being used to describe someone lesser trained, there's a difference here: look up 'psychiatrist' in the dictionary and you'll see it's defined as a physician. Unless you're in your forties (and on SDN, that is within the realm of possibilities), master's level psychologists were around when you began your training. If having exclusive use of the term 'psychologist' meant so much to you, then why did you train in this field? Why not be content in knowing that you're the best trained psychologist?

Originally Posted by cara susanna

The APA's pushing RxP when a lot of us don't want it is exactly the issue I was describing because they are ignoring other issues that are far more important (like protecting our professional turf). But frankly, I don't even think they're doing a great job with RxP, it's only allowed in a few states and I doubt it will ever fully take off. APA is acting like RxP is a cure-all to our problems, so if it passes our field is completely saved. That's definitely not true IMO.

Fair enough, I agree with your assessment of the AP(sychological)A.

But if your educational requirements for doctoral-level training are as high as you claim they are, you have nothing to worry about. Unless NPs radically overhaul their curriculum, they will not ever be a threat to psychiatrists for this very reason. Likewise I hope you are confident in your training and abilities

Fun!

From dictionary.com


psy·chi·a·trist   /sɪˈkaɪətrɪst, saɪ-/ [si-kahy-uh-trist, sahy-]
noun
a physician who practices psychiatry

psy·chol·o·gist   /saɪˈkɒlədʒɪst/ [sahy-kol-uh-jist]
noun
1. a specialist in psychology.
2. Philosophy . an adherent to or advocate of psychologism.

psy·chi·a·try   /sɪˈkaɪətri, saɪ-/ [si-kahy-uh-tree, sahy-]
noun
the practice or science of diagnosing and treating mental disorders.

psy·chol·o·gy   /saɪˈkɒlədʒi/ [sahy-kol-uh-jee]
noun, plural -gies.
1. the science of the mind or of mental states and processes.
2. the science of human and animal behavior.
3. the sum or characteristics of the mental states and processes of a person or class of persons, or of the mental states and processes involved in a field of activity: the psychology of a soldier; the psychology of politics.
4. mental ploys or strategy: He used psychology on his parents to get a larger allowance.

Originally Posted by pysch4sure

You acknowledged Kansas. To me that's belittling the impact of their profession, when there are actually thousands across almost every state.

I am told all the time that psychiatrists aren't really physicians, sometimes from other doctors too. I know two attendings who introduce themselves in public as being 'physicians' instead of a 'psychiatrists' in order to avoid the long explanation that they went to medical school, etc. I assure you, there's not an overabundance of prestige in psychiatry, at least in my limited experience.

In terms of the use of 'psychiatrist' being used to describe someone lesser trained, there's a difference here: look up 'psychiatrist' in the dictionary and you'll see it's defined as a physician. Unless you're in your forties (and on SDN, that is within the realm of possibilities), master's level psychologists were around when you began your training. If having exclusive use of the term 'psychologist' meant so much to you, then why did you train in this field? Why not be content in knowing that you're the best trained psychologist?

Fair enough, I agree with your assessment of the AP(sychological)A.

But if your educational requirements for doctoral-level training are as high as you claim they are, you have nothing to worry about. Unless NPs radically overhaul their curriculum, they will not ever be a threat to psychiatrists for this very reason. Likewise I hope you are confident in your training and abilities

Sorry, I think we had a misunderstanding. I was referring to Kansas only for Masters level clinicians, not school psychologists. It is much more common for school psychologists. I really don't think less of school psychologists, they have a lot of training in assessment and I admire anyone who can work with children.

You're right that it's just a name, but it's what the name represents I suppose. I did overreact, but it's a sensitive topic: we are facing loss of jobs because people would much rather hire Masters level people because they're cheaper. And it's starting to affect testing as well, which I really don't think a Masters qualifies people for (referring to counseling-based Masters and MSWs, not school psych of course). Kind of like how you guys (or most of you, I'm guessing) feel that a Masters in psychopharm doesn't make someone qualified to do RxP.

Originally Posted by cara susanna

Sorry, I think we had a misunderstanding. I was referring to Kansas only for Masters level clinicians, not school psychologists. It is much more common for school psychologists.

You're right that it's just a name, but it's what the name represents I suppose. Sorry, it's a sensitive topic.

Of course it is. We're all invested in our professional identities. We all want to feel that the years we put into schooling is worthwhile, not wasted.

Wskhunky,

I am not in the medical field but I do I have my a Master's in counseling. IMHO I would recommend medical school first mostly because your therapy skills will dwindle while in medical school. Why not just get a psychiatric residency that focuses heavily on therapy or go back to school after your medical training when you can immediately apply it to the patients you are working with?

Many of the previously described criticisms of counseling are accurate although some are not. There is indeed a business to counseling education. Many counselors don't adhere to evidence based treatment. "Real world" counseling looks very different than the models in the research literature. However, the meta-analyses I have seen of therapy as a whole (ie Wampold) and several of the different subtypes (Solution-focused, CBT) have generally supported the idea that psychotherapy is effective as compared to non-directive listening and supportive therapy. My personal experience confirms these beliefs. Although, as previously stated, there is a lot of debate on this.

Oh gosh! It took me until just now to realize that OP meant original poster, which was addressed towards me. I'm so sorry, cara and billypilgrim (i love your metaphor)!! haha.

Yeah, what you all are saying make so much sense. I think the struggle right now, as nitemagi suggested i figure out, is whether I actually want to go to medical school. I was planning to use the one-year master's program (which can be extended to a second year, which allows me to get licensure+ more hours) to figure out if counseling was right for me. And I would be applying to medical school during this first year, and if counseling didn't work out, I would just enter medical school after the one-year program. If it did work out, then i'd have lost $5000+ in apps. It's a slightly roundabout way for me to decide if I want to become a physician or a counselor.

I think the original question I posted was not the best/ didn't properly describe what i was looking for.. I think my actual, more accurate question, is: Is it worth getting a master's degree in counseling (one-year, no licensure) to decide if I want to go to medical school or not? Is there a way to learn whether a full-time job doing therapy fits my tastes better than full-time job with medicine & some therapy, without getting 30K in debt?

Originally Posted by wskhunky

I think my actual, more accurate question, is: Is it worth getting a master's degree in counseling (one-year, no licensure) to decide if I want to go to medical school or not?

No, it's not worth getting the master's degree. It has absolutely nothing to do with medicine or medical school.

Psychotherapy has good evidence. Counseling doesn't.

Confusing, especially since some with counseling degrees do psychotherapy. In fact I've seen several counselors come from training curriculums with better training in psychotherapy than many psychiatric programs. I know several with counseling degrees that do evidenced-based psychotherapy such as CBT and DBT.

Personally, I wouldn't recommend someone get a degree in counseling before medical school. Nothing against that field despite what what my colleagues are saying, though my reasoning is the same above. Time is money. If you want to be a good psychotherapist, you could put your aim on a residency with good psychotherapy training or do psychotherapy CMEs as an attending.

Further, sometimes graduate degrees can help someone get into medical school. Getting in is difficult. The problem with a counseling degree is medical admissions boards are egocentric to a degree bordering if not crossing ignorance. Many, for example, will highly prize a degree in a physical or biological science, such as biochemistry or chemical engineering, but put little value in someone who has graduate training in a social science or a business degree despite that these could have very impressive ramifications in one's future career and contribution to the medical profession.

Two doctors I know of have an MBA and both doctors ended up as head doctors in the business side of some impressive medical organizations in addition to being considered excellent physicians. One of them is now the VP of a large hospital system. Another doctor I know of took a year off of medical school to get a graduate degree in philosophy and he's considered one of medicine's top ethicists. I'm sure someone with a degree in sociology could do a heck of a lot to contribute to the nation's healthcare debate.

Medicine IMHO is too trapped into a physical/biological science mental box. Your degree in counseling could be helpful and I can think of things you can do with it that could even advance the field of medicine, but admissions boards just plain often don't care to hear about candidates who want to go into psychiatry or have degrees in fields outside of physical/biological sciences. They want to hear about candidates that want to go into fields that the people in the admissions board are in or mimic their own field. E.g. the anatomy professor may favor people who want to go into surgery.

IMHO I would recommend medical school first mostly because your therapy skills will dwindle while in medical school.

Agree with this as well which is ironic given that doctors ought to have more training in bedside manner. It's as if the only thing medical faculty care about is scores on multiple choice tests.

I don't know if I am explaining my situation clearly.. =T.

Regardless if I do a master's degree in counseling or stay in my position as a research tech in a children's hospital, I would still be taking two years off before going to medical school. The only thing I would be missing out on, if I were to do the counseling program, would be a possible publication and 30K in loans. I don't think I would be losing time. Does that change how you all would approach this problem?

Thanks so much for you all's advice! It has given me so much to think about.

"The problem with a counseling degree is medical admissions boards are egocentric to a degree bordering if not crossing ignorance."
Whopper, Could you explain this reasoning?

IF and when you are in medical school, run an experiment.

Have 10 people talk to a microbiology professor with 5 people pose as people wanting to go into infectious disease, and another 5 as wanting to go into psychiatry and see the facial expressions and the comments the microbiology professor says to everyone.

I was in an incident in medical school where one of America's most highly respected infectious disease doctors raised his voice against a colleague of mine because she wanted to go into psychiatry, saying she was too good for it.

Medical doctors within certain fields tend to knock MDs in other fields. Doctors, in general, also never like to be told they are wrong especially with someone with a lesser amount of education, and several tend to have a "woe is me" attitude that their field is the toughest, and thus are more deserving of respect.

And the mental health field is in the minority in medical academia...hence most medical schools tend to have an anti-psychiatry culture.

Well if you really want to be a counselor that is up to you but you could probably do something worthwhile with your life. What would the world be like without 'professional' (ha!) counselors? It certainly wouldn't be worse, and might be a better place. I have my biases (though supported by the evidence) but I usually steer people away from becoming a counselor.

Originally Posted by wskhunky

Regardless if I do a master's degree in counseling or stay in my position as a research tech in a children's hospital, I would still be taking two years off before going to medical school. The only thing I would be missing out on, if I were to do the counseling program, would be a possible publication and 30K in loans. I don't think I would be losing time. Does that change how you all would approach this problem?

No.

Getting the masters and working full-time using that degree for several years (at least long enough to get licensed) might look interesting- IF the rest of your application is strong. The masters itself- without the subsequent work experience- would not provide 1) enough coursework and fieldwork for you to develop the psychotherapy skills you say you want or 2) enough experience to really make your med school application stand out. Not to mention, the #1 question you would be asked at every interview would be "Why the change to medical school?" and "I want to do psychiatry but I don't think it provides the depth of training I want" would ruffle some feathers.

Now I'm being egocentric because I'm thinking of how it was for me in medical school.

In a medical school curriculum, you're literally doing the equivalent of about one weeks worth in a day, day after day, and getting your butt kicked. It could help you to take some classes that are part of the medical curriculum before you actually take them in medical school.

I'm being egocentric because I kept wishing I had taken some of the classes before because I felt it was too much information all at once. You might not have the same experience. I've seen plenty of non-science majors do fine in medschool, though the majority felt it was too much information all at once.

Thank you for your response-- it's given me much to think about!

Just to give you an example, biochemistry is a very tough course. If you've taken organic chemistry, I'd say it's on the same order of difficulty. Imagine taking a course as difficult as orgo on the order of one week's worth in a day. That's what's going to happen in medical school x 6 given that every class is taught like that.

I'd compare medical school to human equivalent of the most intensive data compression program. I'm biased. I'm a Myers-Briggs ENTJ, the personality type that hates medschool the most.

Whopper-- unfortunately, I really enjoyed ochem. xD. But I understand the point you are trying to make. I've heard medical school is "like finals' week, every day, except you're learning the information for the first time".

Pingouion-- Thank you for the possible questions I might be asked. I'm taking those into consideration as i decide if doing a counseling program is needed to figure out what i really want to do in the future!

You might be able to do a counseling program that allows you to take med courses as an elective, though who in their right mind wants to take Histology as that?

I think you might know yourself and your own style of learning, though, too. Med school is different for everyone. I found it very manageable and probably more so than any previous schooling I've had. Particularly because it's so obvious what you have to learn and "what goes in the head, must come out" without any much thought or manipulation. I am very glad I didn't take any medical classes as an undergrad, for those reasons, and tried to do lots of humanities.