Do Psychiatrist and Psychologist get along?

[psychMDhopefully]

Or is it one of those, " Why do they get paid more than me" forever inferiority complex type deals? I've heard psychologist say psychiatrist shouldn't do cbt and other forms of therapy, when it is psychiatrist who pioneered it. That's kinda insane to me but I've heard worse things.

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[erg923]

Well, I do regularly play the classic "why are you hitting yourself" game with the psychiatrist in my clinic.

 

[deleted343839]

Or is it one of those, " Why do they get paid more than me" forever inferiority complex type deals?

It's not an existential sort of question. No one has ever asked me that, actually, but if they did I'd show them a typical template for a psychiatric practice and a fee schedule. There's no mystery there.

 

[PsyDr]

Medicare requires a referral from a physician. Guess which type of physician has a panel of patients who need psychological care? Between a jerk and someone who is actually nice, guess which one a psychiatrist is gonna refer to.

On a personal level, how hard is it to have a rich friend with similar interests?

In order of frequency, I hang out with neurosurgery, psychiatry, ortho.

 

[smalltownpsych]

Some psychiatrists have expertise in psychotherapy, others do not. If they don't but they like to pretend they know what they are doing then its generally no different than the other people in the patients life who want to tell them what to do. As far as making more money, I focus more on increasing my own revenue stream as opposed to comparing to others. Besides if I start to feel inferior I could always just smoke bigger cigars to compensate.

 

[Therapist4Chnge]

Mostly not. There are always some ppl who can't play well with others, regardless of their training. There are definitely differences of opinion when it comes to case conceptualization, but again that happens across specialties. I personally don't interact much w. psychiatrists (other than taking some neuropsych referrals here and there).

As for who "pioneers" psychotherapies, that is more up to what orientation(s) you practice. Tge vast majority of peer-reviewed research related to psychotherapy comes from psychologists, so there is also that to consider.

 

[BuckeyeLove]

in terms of clinical work i have always gotten along with my psychiatry colleagues. in terms of the forensic evaluation arena...not so much. IMHO they dont do anything but proffer qualitative opinions without any psychometric basis, so in my mind we do everything and more.

 

[IT514]

I'm in a good psychiatry department. The culture is generally collegial between all types of providers. My salary is pretty damn good for the hours I put in and I get to see patients within my niche. No weekends or call for me and no back to back to back 20 minute appts. I field quite a few consults from psychiatrists who need my expertise and know to value it, and vice versa. Based on my experience as a neuropsychologist, I'd rather be housed with a good psychiatry dept. than any other specialty.

 

[Therapist4Chnge]

I'm in a good psychiatry department. The culture is generally collegial between all types of providers. My salary is pretty damn good for the hours I put in and I get to see patients within my niche. No weekends or call for me and no back to back to back 20 minute appts. I field quite a few consults from psychiatrists who need my expertise and know to value it, and vice versa. Based on my experience as a neuropsychologist, I'd rather be housed with a good psychiatry dept. than any other specialty.

I'd offer Neurosurgery or Physical Medicine & Rehabilitation as good alternatives for people looking. Sometimes Neurology can be a good fit too, though it depends on the kind of patients you want to see.

The only real issue I've had with psychiatry has to do with forensic work (as BuckeyeLove mentioned). Psychiatrists who are fellowship trained in forensics and utilize psychometric measures are in the minority, unfortunately.

 

[Ollie123]

IMHO they dont do anything but proffer qualitative opinions without any psychometric basis, so in my mind we do everything and more.

Did internship as part of an incredibly well-regarded forensic psychiatry program and I cannot emphasize this point enough. "Why i do not attend case conferences" comes to mind. It did little besides convince me that our legal system is a farce and forensic psychiatry is mostly about getting enough prestigious credentials that you can get away with making up "medical opinions". Slap a Harvard degree on a program that pulls random sentences from forensic textbooks and we could probably save our legal system a lot of time and money.

That said, I understand empirical research on a lot of the issues encountered can be difficult, given the incredibly low base rate of many of the things we saw.

 

[WisNeuro]

I'd offer Neurosurgery or Physical Medicine & Rehabilitation as good alternatives for people looking. Sometimes Neurology can be a good fit too, though it depends on the kind of patients you want to see.

The only real issue I've had with psychiatry has to do with forensic work (as BuckeyeLove mentioned). Psychiatrists who are fellowship trained in forensics and utilize psychometric measures are in the minority, unfortunately.

I'd second this. My best referrals come from Neurology and PM&R. My psychiatry referrals are usually garbage. Mess of psychiatric issues and some kind of secondary gain. Then it's hit or miss on whether the referring provider understands what I'm talking about when I say the evaluation was invalid due to below chance responding on certain measures.

 

[Sanman]

I regularly square off with them in caged death matches, so they are not fond of me.

Really though, I cannot imagine why a psychologist would have discord with a psychiatrist in most real world. I have a problem with incompetent people regardless of the letters after their name. As far as psychiatrists doing CBT. I have no problem with them doing psychotherapy if they are properly trained. However, many people are not properly trained and attempt to provide sup-optimal care for money. I have a problem with this as lax standards of care contributes to decreased reimbursement and lack of renumeration for expertise (if I provide high quality care that includes proper assessment, behavioral expertise, communication with others providers/family, I am paid the same as someone who does none of this in our current fee for service model) If anything, I see it more with counselors or social workers than with psychiatrists as they make more money providing meds to people. Do I feel that quality of care is poorly compensated in our current healthcare model (or not compensated for at all)? Yes. Do I blame psychiatrists for that or really any provider that is responding to market forces? No

 

[PsyDr]

in terms of clinical work i have always gotten along with my psychiatry colleagues. in terms of the forensic evaluation arena...not so much. IMHO they dont do anything but proffer qualitative opinions without any psychometric basis, so in my mind we do everything and more.

From a justice point of view, this is bad.

From an economic point of view, this is an incredible opportunity for others. Some psychologists have made a career by expressing a Lewis black level of incredulity at the stupid things people say.

 

[smalltownpsych]

From a justice point of view, this is bad.

From an economic point of view, this is an incredible opportunity for others. Some psychologists have made a career by expressing a Lewis black level of incredulity at the stupid things people say.

Speaking of forensic psychiatrists who make opinion statements without anything to back it up. Have you ever seen this guy on tv?

To be fair, I have seen a few psychologists on the news who make similar types of overgeneralized and unsupported claims and if I was on tv answering some of the types of questions with layers of inaccurate premises that are often asked, don't know how much better I would do. Although I'm sure I wouldn't be as bad as Dr. Ablow.

 

[Therapist4Chnge]

To be fair, I have seen a few psychologists on the news who make similar types of overgeneralized and unsupported claims and if I was on tv answering some of the types of questions with layers of inaccurate premises that are often asked, don't know how much better I would do. Although I'm sure I wouldn't be as bad as Dr. Ablow.

It blows my mind how nonchalant some "experts" can be on television and in print (admittedly both can be taken out of context). I'm not sure if it is in response to see this (and/or due to my mentors beating into me that everything I say/write I better be able to defend on the stand), but I'm waaaay more conservative when I'm speaking to the media, public officials, or even other professionals. I'd probably make for a boring guest on a talk show because my darn ethics would get in the way of saying anything provocative.

 

[DynamicDidactic]

Something to consider, if you work in a psychiatry dept and you are not a psychiatrist there is a latent differential. If you work in a group practice, the setup is more equal. Note, these are just generalities and each setting will be different.

My small (internship) level of experience lead me to a strong desire to never work in a psychiatry department. Though, I understand that my anecdotal experience is not representative of all psychiatry departments. Psychiatrists are people and people differ in their respect for, knowledge of, and interest in other allied mental health fields.

 

[psychMDhopefully]

It's not an existential sort of question. No one has ever asked me that, actually, but if they did I'd show them a typical template for a psychiatric practice and a fee schedule. There's no mystery there.

I said things about the pay, I actually have no idea how much phd or psy.d psychologist get paid.

 

[IT514]

I'd second this. My best referrals come from Neurology and PM&R. My psychiatry referrals are usually garbage. Mess of psychiatric issues and some kind of secondary gain. Then it's hit or miss on whether the referring provider understands what I'm talking about when I say the evaluation was invalid due to below chance responding on certain measures.

For regular outpatient referrals, sure, but I see mostly neurodegenerative from either. But as for where I'm housed, from an operations/business standpoint, I would rather be with Psychiatry than Neurology any day. This is just from my own experience. Interestingly, I find that my psychiatry colleagues have a very good understanding of PV/SV issues, and for neurology its more hit or miss.

 

[WisNeuro]

For regular outpatient referrals, sure, but I see mostly neurodegenerative from either. But as for where I'm housed, from an operations/business standpoint, I would rather be with Psychiatry than Neurology any day. This is just from my own experience. Interestingly, I find that my psychiatry colleagues have a very good understanding of PV/SV issues, and for neurology its more hit or miss.

I'll trade you some of my Neurologists for some of your psychiatrists Outside of one ARNP, who listed in a note that one patient's entire history of criminal behavior was due to a mTBI due to mild encephalomalacia evident on imaging. She also said that the anterior temporal lobe is "where memories are housed" in the note. Never mind that the criminal history far preceded the mTBI in question. Neurology here is decent

 

[IT514]

Theres a trend I've experienced with neurology over the years, that referrals appear to fall into one of two categories. They either want me to do their work for them, or they view me as a tech (i.e. just do the testing I don't care about your opinion). Neurosurgery has been awful in the latter regard, I mean just abysmal. I hate attending DBS meeting but I feel like someone has to scream to these people that surgery might not be a good idea for someone who is approaching a moderate dementia. Psychiatrists, again in my experience, seem to be better listeners.

 

[WisNeuro]

My experience is that we get a ton of psychiatry referrals when they are not sure what is going on, so they just tack on "memory" somewhere in the consult. Many of these end up being PVT failures. My current base rate is at 52.3%

 

[Therapist4Chnge]

Theres a trend I've experienced with neurology over the years, that referrals appear to fall into one of two categories. They either want me to do their work for them, or they view me as a tech (i.e. just do the testing I don't care about your opinion). Neurosurgery has been awful in the latter regard, I mean just abysmal. I hate attending DBS meeting but I feel like someone has to scream to these people that surgery might not be a good idea for someone who is approaching a moderate dementia. Psychiatrists, again in my experience, seem to be better listeners.

That's rough. Our Neurology referrals tend to be: vague memory complaints (almost always psych), dementia evals (bread & butter), seizures (total crapshoot), and MS (cog/return to work). I try and stick w internal referrals who best understand what I/we do, as I have limited spots for these cases. The SVT/PVT thing is definitely an issue w outside referrals.

Our Neuro Surg won't cut w/o evals. They learned to trust us bc most of their nightmare cases could have been avoided if they listened to the recs. i have heard mixed reviews at other hospitals, so YMMV.

Psychiatry has been a mixed bag (in regard to clinical work). I have a guy I really trust...and then everyone else. I'm sure that dynamic happens in a lot of other specialties too.

 

[psych.meout]

That's rough. Our Neurology referrals tend to be: vague memory complaints (almost always psych), dementia evals (bread & butter), seizures (total crapshoot), and MS (cog/return to work). I try and stick w internal referrals who best understand what I/we do, as I have limited spots for these cases. The SVT/PVT thing is definitely an issue w outside referrals.

Our Neuro Surg won't cut w/o evals. They learned to trust us bc most of their nightmare cases could have been avoided if they listened to the recs. i have heard mixed reviews at other hospitals, so YMMV.

Psychiatry has been a mixed bag (in regard to clinical work). I have a guy I really trust...and then everyone else. I'm sure that dynamic happens in a lot of other specialties too.

Could you talk a bit more about this kind of stuff? What would constitute a "nightmare case" and how would a neuropsych rec help them avoid it?

 

[PikminOC]

Just like any relationship, there are some therapists I get along with and some in dont. You get used to the way the therapist works. This works both ways.

 

[AcronymAllergy]

Could you talk a bit more about this kind of stuff? What would constitute a "nightmare case" and how would a neuropsych rec help them avoid it?

T4C will obviously be able to clarify better than me, but I'd imagine it may have to do with things such as operating on folks where the neuropsych eval suggested they may experience significant/near-catastrophic memory loss, were at significantly increased risk for negative outcome due to existing cognitive impairments, were at increased risk of post-surgical complications or suboptimal outcome because of emotional/characterological factors, etc. Something along those lines.

 

[Therapist4Chnge]

T4C will obviously be able to clarify better than me, but I'd imagine it may have to do with things such as operating on folks where the neuropsych eval suggested they may experience significant/near-catastrophic memory loss, were at significantly increased risk for negative outcome due to existing cognitive impairments, were at increased risk of post-surgical complications or suboptimal outcome because of emotional/characterological factors, etc. Something along those lines.

Spot on. Neuropsych evals for the former and a more pain & psych focused eval for the latter. There is some nice literature that support both, which is important to lean on for the cases where there is an external "push" to get a patient in.

 

[Acronym1]

I guess they must have historically since the "founders" of psychology - Freud and Jung, were actually medical doctors (neurologists and psychiatrists) not psychologists, which is really weird.

 

[Mad Jack]

They frequently engage in fisticuffs in the alleyway behind my hospital. A greater blood fued the world has never known.

 

[Acronym1]

I have encountered both in my younger days, and did not find any perceivable tension between the two creatures. The psychologist was a bit more hesitant, played by the book more, while the psychiatrist was more assertive.

 

[Jegg]

The psychiatrists I've encountered are inquisitive and interested in my work, and are eager to share knowledge. One of my good friends is a psychiatrist, who I met at a Further concert. Great guy who who is passionate about helping others. Generally we're all in it to help people the best we can with the tools we have.

Off the record, psychaitrists generally lose to psychologists in Fight Club. Psychologists fight dirty! Nurses kick all of our butts though...