Why do psychiatrists make so much more money than psychologists?

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opheracco

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The title says it all.

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Because we as a profession have done a very poor job promoting ourselves, our value to the community, and what we do. Politically we are ill-represented, and it shows in the laws.

I'll never forget lobbying a few years ago at the state level, and I was speaking with a state representative and though they was receptive to speaking (and a genuinely nice person), they had no idea the difference between Psychology and Psychiatry.....yet was frequently required to make decisions about passing/rejecting legislation that effect both groups. Even after some clarification and information, the areas still were confused on the floor.
 
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Psychologists are too riven by differences and too poorly organized to effectively promote the profession. The APA itself is a shining example of inefficiency and lassitude. Psychologists could look to the actions of the NASW - the National Association of Social Workers to see how a profession can advocate for itself. Of course, social workers thrive on tilting at windmills and other sundry crusades so they have become quite good at advocacy!
 
"before i began doing research and looking at getting the clinical phd, i worked in advocacy (MH issues) at the state level for a number of years, and continue to do so now. it was AMAZING(horrifying) how many profs. I interviewed with saw my commitment to advocacy, an my belief that psychology needs to better represent itself and take a stand on issues that directly relate to MH, social justice, etc, as a liability, and told me the others in the department weren't interested in such issues. issues like MH parity. it was really disappointing."



Call me a rebel, but I firmly believe that advocacy within larger systems such as the political arena needs to be a part of our skill set. Just as psychologists are expected to develop skills in assessment, intervention, developing personal relationships, multicultural competence etc... experience in advocacy should be a professional competency developed during our training. Clinical psychologists have the highest level of training of any mental health professional, the most advanced research skills, and we have the most advanced and prestigious academic degrees. An army of Ph.d.'s with sophisticated research skills has the potential to move mountains. Unfortunately the profession seems unwilling to develop in that direction. In my opinion more leadership from APA is needed to incorporate advocacy training into graduate curricula.
 
In my opinion more leadership from APA is needed to incorporate advocacy training into graduate curricula.

That's an interesting point, but getting psychologists to move in the same direction is much like herding cats.

Mark
 
A psychiatrist is a trained medical physician, a psychologist is not.
 
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I think one large problem is that the profession of psychology and all its various degrees are way too confusing and promote too much infighting. You have school psych, clinical, industrial psych, experimental, counseling etc. Not to mention have all these different types of degrees- masters, psyd and phd- each with their own set of restrictions and guidelines.

The APA really needs to streamline all these different degrees. They should try to take pointers from other professions that are more successful at promoting themselves. Much like medicine, there should be one “practicing degree” and one “academic degree” and that’s it (and of course a combination, if desired). People would choose specializations after a few years, and become whatever type of psychologist they want. The way its set up now promotes so much infighting and maneuvering that the profession cant even resolve issues among itself, let alone promote it to outsiders.
 
A psychiatrist is a trained medical physician, a psychologist is not.

Pretty impressed with yourself huh? It takes us 6 years from the 1st year through licensing. A psychologist is a doctoral level provider. The training time and intensity is comparable.
 
Right, and a Psychiatrist, no matter how large his ego, is not a psychologist.

Mark

What I think is even more interesting and even worth studying is that if you look at all the responses to this question by psychologists and students you see a trend--sophisticated, nuanced attempts to look at the problem from many different angles. The one MD comes on with a black and white answer.
 
I would just like to point out that I personally think cognitive therapy and other psychological therapies are light years ahead of what drugs can do, and I think it's a shame that psychiatry seems to be so medication driven.

Just thinking about over-prescription of Ritalin makes me nervous.
 
What I think is even more interesting and even worth studying is that if you look at all the responses to this question by psychologists and students you see a trend--sophisticated, nuanced attempts to look at the problem from many different angles. The one MD comes on with a black and white answer.

Well, here's another MD answer.

I don't know. You should. And I shouldn't be pressured financially to forgo doing psychotherapy with patients because I can make more doing med checks.
 
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Well, here's another MD answer.

I don't know. You should. And I shouldn't be pressured financially to forgo doing psychotherapy with patients because I can make more doing med checks.

Making my point, again. If psychiatrists want to come on here and say "because we are smarter and we deserve it" or even better "I don't know" then why post? I don't know the answers to most questions on SDN forums, so I don't try to answer them.
 
Combination of factors really.

I'd say medication is probably the biggest factor, so I think a big part of it is just volume. 15 minute med checks (while arguably a crappy system to begin with) results in many more patients per day. You simply cannot do 15 minute therapy sessions (at least not effectively).

Psychiatrsts who do want to be involved in therapy typically have to take a pretty enormous pay cut from it. It doesn't drop them quite to psychology level, but the salaries are MUCH closer if you look at a psychiatrst who primarily does outpatient therapy vs. one who does primarily medication management.

My "second choice" career probably would have gotten me triple the starting salary I'll make as a psychologist, with even more on the later end, so obviously money isn't a big concern of mine. I don't expect to earn as much as I would have if I went to med school, I don't care because I get better training in the things that I want to do by going this route, and will get the career I want.

Besides, if I was earning that much chances are most of it would just end up sitting in my bank account anyways. I don't need terribly much money to live:)
 
Possibly supply and demand....it is easier to take a pill than to work on problems (although when possible, the outcome seems that gains are maintained better with therapy because patients have an internal locus of control and can attribute the change to themself, increase coping skills for future problems, etc). But, really sometimes it is necessary to use medication.

And obviously, drug companie$.
 
A good psychologist is worth his weight in gold. I was just answering the question posed...
 
Well, here's another MD answer.

I don't know. You should. And I shouldn't be pressured financially to forgo doing psychotherapy with patients because I can make more doing med checks.

Well with that logic, once we take the required coursework we should get our Rx Privs and psychiatry should be welcoming this change, finally freeing you all from dreaded med checks. Oh wait, that means that you would have competition, something you absolutely fear from psychologists. Why is there all this fear from the field of Psychiatry?

After all, it's clear to all involved that psychologists on average have more training in psychotherapy than psychiatrists, despite this psychiatrists think that they should be able to engage in psychotherapy. Psychiatry, as a field, gets its panties in a twist when psychologists suggest it should be a two way street.

Mark
 
Possibly supply and demand....it is easier to take a pill than to work on problems (although when possible, the outcome seems that gains are maintained better with therapy because patients have an internal locus of control and can attribute the change to themself, increase coping skills for future problems, etc). But, really sometimes it is necessary to use medication.

And obviously, drug companie$.

This is kind of where I fall. It's funny that I got so into the tangent, because I don't really have a dog in the fight. I actually think I make about as much as I should based on the demand vs. supply of the skills I have acquired. If I wanted to make as much money as a psychiatrist, I would be a psychiatrist.

I bring a skill to the marketplace and it determines what I am worth. If people would rather take a pill and make everything alright, (and pay more for it) that's OK.
 
Well with that logic, once we take the required coursework we should get our Rx Privs and psychiatry should be welcoming this change, finally freeing you all from dreaded med checks. Oh wait, that means that you would have competition, something you absolutely fear from psychologists. Why is there all this fear from the field of Psychiatry?

After all, it's clear to all involved that psychologists on average have more training in psychotherapy than psychiatrists, despite this psychiatrists think that they should be able to engage in psychotherapy. Psychiatry, as a field, gets its panties in a twist when psychologists suggest it should be a two way street.

Mark

Um, I actually support RxP for psychologists and have said so in these threads before. So don't use my post as an example of psychiatrist hypocrisy when I'm not being hypocritical. :rolleyes:
 
Making my point, again. If psychiatrists want to come on here and say "because we are smarter and we deserve it" or even better "I don't know" then why post? I don't know the answers to most questions on SDN forums, so I don't try to answer them.

Well, yeah. That's why I didn't post in this thread in the first place until people started saying that all psychiatrists were arrogant jerks based on one jerky reply from a psychiatrist. :laugh:

The rest of this discussion is interesting though. :)
 
Well, yeah. That's why I didn't post in this thread in the first place until people started saying that all psychiatrists were arrogant jerks based on one jerky reply from a psychiatrist. :laugh:

The rest of this discussion is interesting though. :)

It's okay all....psychologists and psychiatrists can play together, though sometimes we get in some tussles.

Sunlioness has been supportive of our field, and I think we all need to recognize that we sometimes generalize a bit too much.......myself included.

As for the discussion, I'd like that to continue, as I think it is an important discussion.....though we need to step away from the back and forth between the psych's. ;)
 
I think the discrepancy likely stems from differences in the historical roots of the professions, rather than from differences in current skills, training, or workload. As someone astutely pointed out above, psychiatrists are 'trained medical physicians.' They are involved in a subspecialty of medicine. Clinical psychology was originally a research-based, academic discipline. In general, physician salaries are much higher than salaries for professors.
 
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A psychologist that is really good at marketing themselves is in a better professional position of choice. If a patient can't get a med check covered by a provider, generally they are going to to go to someone who is covered by their insurer. Loyalties aside. Also, some folks will just tell their GP what the psych prescribed and the GP takes over. Many of the established psychologists that I know don't file for their patients. They go out of a system, and the patient stays. There is a more established relationship from hour long therapy sessions vs. 15-30 minute med checks. Also, how annoying must it be for a psychiatrist to see the results of GP prescribing errors. I had a GP that was always trying to give me meds when I was stressed. It was normal life stuff, but there had to be a quick fix. It's not like a rash, good grief.

As a lawyer in a large law firm, I make more than my cousin who is a physician in SF. I also didn't have the debt he did - nowhere close. My job is intellectual stimulating, etc. I deal with people constantly, but most of my interactions with people are rather impersonal and fairly brief. I am actively looking to leave the profession though because $$$ isn't everything.

I think that with RxP, ideally, the answer to the original question some day might be "they aren't" or "they aren't paid much more" (paid more that is) at least between prescribing psychologists and psychiatrists.

Why isn't everyone annoyed with social workers and master's level practitioners? That's where the pressure is coming from on the therapy end. It seems like in some cases the severity of the presenting pychopathology must be considered - where the extra years from a PhD or MD would justify that level of practitioner. I guess it's all because of the fuzziness of the diagnosis.
 
It seems like in some cases the severity of the presenting pychopathology must be considered - where the extra years from a PhD or MD would justify that level of practitioner. I guess it's all because of the fuzziness of the diagnosis.

Insurance companies don't see it that way, unfortunately. I've decided to not deal with insurance when I setup a practice.....though I also don't plan on seeing more than a few people a week, so I'm not that concerned with filling a bunch of time slots.
 
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Why isn't everyone annoyed with social workers and master's level practitioners? That's where the pressure is coming from on the therapy end. It seems like in some cases the severity of the presenting pychopathology must be considered - where the extra years from a PhD or MD would justify that level of practitioner. I guess it's all because of the fuzziness of the diagnosis.

I would say that there exists at least a passive acrimonious undertone from psychologists (especially those that were trained at fully-funded programs) to master's level clinicians. In my opinion, there is a saturation in the 'therapy' profession as it is brimming with master's level clinicians and those who received training from professional schools. As a result, there is only a 'small piece of the pie' left for clinicians from funded programs to treat. There is a ton of mediocrity in the field and it is hard for clients to tease out the average from the skilled. A keen marketer does not make him/her a skilled clinician and this must be hard to swallow for the psychologist.

T4C speaks for generalization and I think he is right. I do it too. There are many strong diagnosticians/practitioners at the masters level....with many sub-par psychologists, despite their excellent training, in the field. It is too easy to generalize rather than see clinicians as individuals and sole practitioners.

I think I am a skilled diagnostician! :)
 
Hi, as I was reading over the thoughts on this site it occurred to me that the training for all psychologists and psychiatrists ought to include opportunities for students to experience for themselves the kinds of things that their future clients and/or patients will experience. All student psychiatrists and psychologists ought to attend a therapy session and an assessment session with a psychologist and a psychiatrist (and do this without letting on your are gathering your own information from the experience). Everyone has stuff they could talk to someone about, and then have a feel for what is actually going on out in the field. Decide then for yourselves how you would want to be perceived, greeted and treated. I teach Psychology in high school and from what I'm gathering it seems that when you are in the "people business" (education, psychologists, psychiatrists etc.) as opposed to the oil and gas industry for example, it is important to know what the experience is like for the client/patient. From my understanding psychologists do have to experience therapy themselves and is part of the training. I don't know about psychiatrists.
Do psychiatrists need to experience the kind of assessments that they inflict (I mean administer) to people? Anyway, that was tongue and cheek. The bottom line is that there is a role for both psychologists and psychiatrists in our society, but for the most part it seems to me that people are often treated as "less than" or "lower than" when the step into a psychiatrist's office than in a psychologist's office. In a psychiatrist's office people are looked at as flawed and that they need to be fixed, while a psychologist seems to find the problems in the person's life and assist them with coping skills. The same thing happens in the education system. In education some students are looked at as being flawed needing to be fixed, while other teachers will look at the whole student and note that maybe Johnny didn't do his homework because his parents were keeping him up all night fighting etc. There is always a bigger picture to what goes on in humans. We are a complex bunch, but arrogance should never be tolerated when someone is vulnerable regardless of the profession. I do not think that psychiatrists ought to be paid outlandish salaries for the work they do nor do I think that arrogance ought to raise it's ugly head when dealing with vulnerable people.
Remember you are in the people business and not the money business. Professionals are not immune to failing to meet the needs of vulnerable people when money becomes the motivator to enter the "people business."
 
A psychiatrist graduates from medical school with an M.D (average cost of ($150,000) and spends 4 years in residency (with a pay of about $43,000 per yer). Thats a total of 12 yrs of training (4 yrs college, 4 medical school, 4 residency) and heck of alot of debt. We have licensing ability to manage medications. Psychologists and the therapy they provide play a critical role in the treatment of mental illness. So do medications.

Not all psychiatrists care to do talk therapy. And when they do, the training is available to them. I happily refer.

The assumption that all psychiatrists look down on psychologists is rather silly. If anything, we are compared to other physicians, not psychologists, and we are at the bottom of the totem pole in that regard.
 
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average psychologist:

4 yrs college, 5 years grad school, 1 year internship, 1 year postdoc (11 years versus 12 years).

For specialty training, it's 4 yrs college, 5 years grad school, 1 year internship, 2 years postdoc (12 years versus 12 years).

Of course, psychiatrists can do advanced fellowships as well, which ads to their training time.

On average, I think psychiatrists earn more money because they are physicians and, as such, are 1) a more established commodity in the public's eye, the "physician" title come borne with gravitas that "psychologist" does not 2) the AMA is a better organization at protecting scope of practice and supply than is the APA 3) Pharmaceutical companies are a powerful lobby that have been very influential in how psychiatry is practiced 4) billing support in large organizations is usually top notch for physicians and somewhat scattershot for psychologists (this effects reimbursement rate for services) 5) legal hurdles with respect to defining roles (e.g., some states balk at neuropsychologists diagnosing alzheimer's disease, AAN recently tried to leave neuropsychologists our of the diagnostic tree for mild traumatic brain injury [crazy given who drives the research and the testing necessary to properly Dx].


Why would AAN try to leave neuropsychologists out of decision making in regards to mild TBI?
 
I'm generalizing here a little

But maybe psychologists have the option to not be in dept (i.e. picking a funded program) and psychiatrists are more frequently sued for malpractice than psychologists?

The psychiatrists will usually earn more and can do therapy like psychologists can. However psychiatrists (unless an MD PhD) are not really trained as philosophers. I feel like they qualitatively different disciplines that CAN serve the same purpose but often don't.

Psychiatrists dominate a little with the prescription they just have more of a monopoly. Whereas in therapy, psychologists compete with masters-level therapists. Hence the lower pay? Economic theory of demand and supply

But SERIOUSLY, REALLY?! for people who are supposed to be well educated, be respectful to other professions/career options - check yourselves, tone that ego down. And especially towards those who think they're better because they earn more... please, we need more people who aren't in it for the money. Of course, not all MDs are like that, but it does bother me listening to my friend talk about how he'd be upset if he earned less than 150k as a doctor followed by the statement that he isn't in it for the money. I found my other friend who went into medschool unsure of his financial goals much more respectable.
 
I've heard that a clinical psychologist a) in private practice, b) is trained in RxP, or c)both, can make a pretty good living (easily 6 figures). Can anyone else elaborate on this?
 
This forum seems to recycle the same two topics over and over and over and over again....

professional schools, and money.

Lather, rinse, repeat. Lather, rinse, repeat.
 
On average, I think psychiatrists earn more money because they are physicians and, as such, are 1) a more established commodity in the public's eye, the "physician" title come borne with gravitas that "psychologist" does not

Amen to that. When people ask me my career and inform them I'd like to go into psychology, I always hear from my family (full of MDs) and from my boyfriend's friends (DOs) "Why don't you go to medical school and become a psychiatrist?" Because its not the same d@M# thing!!

The stigma is certainly there. You always hear people go, "Oh you're a doctor?" then once informed that one is a PhD vs. a physician, they're quite disappointed. Hence this shirt: http://www.cafepress.com/+trust_the_phd_tshirt,350358561
 
The focus of this thread is exactly the reason psychologists don't make as much. As a profession, we spend so much time comparing ourselves to other professions (we are better than master's level clinicians, should be making as much as psychiatrists, etc), rather than carving our own niche in the health care world. We are not the same as psychiatrists, even if we were given Rx privileges. We are trained in a different tradition (philosophy vs. medicine). If you wanted to do what a psychiatrist does (including take in their salary), you should have gone to med school. It is a shame that therapy is not reimbursed by insurance companies as well as med checks, but that is our fault. We spend too much time commiserating with each other about how unfair the salary disparity is, and too little time advocating for change. And actually, if you compare psychologists to other PhD's (which is what we should be comparing ourselves to), we are on the higher end of the salary scale.

Additionally, from what I know about health care reform, we should all be expecting a huge shift in our role in health care. From what I have learned, it seems psychologists will be more in the treatment planning and administrative role, rather than the actual clinicians carrying out treatment. It looks like psychologists will eventually be working in primary care settings as supervisors of master's level clinicians who are performing the actual therapy. However, I don't think this is necessarily a bad thing. This is an area where we are highly trained and no other profession is comparable in that regard. And actually, if we really carved out that niche, we could conceivably be the supervisor of interdisciplinary treatment teams that include psychiatrists in addition to other clinicians. Perhaps, if we can work on advocating our role in this area, salary increase will not be far behind.

And as an aside, this transition makes sense because (despite what we would like to think) the research shows there is no difference in treatment outcomes based on years of education of the clinician. That is because (speaking from personal experience--I have a master's in counseling and am now in a clinical psych phd program) master's programs solely teach therapy theories and techniques, while psychology programs teach that plus a deep understanding of the human mind/behaviors (i.e., context) from multiple perspectives (e.g. medical, behavioral, interpersonal, etc.), as well as extensive training in the scientific method. This puts us in a unique position to fully understand the the patient's problems from multiple perspectives, determine the best treatment and develop a plan to carry it out. No other profession has the training to do that as successfully as psychologists.
 
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Amen to that. When people ask me my career and inform them I'd like to go into psychology, I always hear from my family (full of MDs) and from my boyfriend's friends (DOs) "Why don't you go to medical school and become a psychiatrist?" Because its not the same d@M# thing!!

The stigma is certainly there. You always hear people go, "Oh you're a doctor?" then once informed that one is a PhD vs. a physician, they're quite disappointed. Hence this shirt: http://www.cafepress.com/+trust_the_phd_tshirt,350358561

What does the fine print say? Can't read it... enlarged image won't load for me
 
The focus of this thread is exactly the reason psychologists don't make as much. As a profession, we spend so much time comparing ourselves to other professions (we are better than master's level clinicians, should be making as much as psychiatrists, etc), rather than carving our own niche in the health care world. We are not the same as psychiatrists, even if we were given Rx privileges. We are trained in a different tradition (philosophy vs. medicine). If you wanted to do what a psychiatrist does (including take in their salary), you should have gone to med school. It is a shame that therapy is not reimbursed by insurance companies as well as med checks, but that is our fault. We spend too much time commiserating with each other about how unfair the salary disparity is, and too little time advocating for change. And actually, if you compare psychologists to other PhD's (which is what we should be comparing ourselves to), we are on the higher end of the salary scale.

Additionally, from what I know about health care reform, we should all be expecting a huge shift in our role in health care. From what I have learned, it seems psychologists will be more in the treatment planning and administrative role, rather than the actual clinicians carrying out treatment. It looks like psychologists will eventually be working in primary care settings as supervisors of master's level clinicians who are performing the actual therapy. However, I don't think this is necessarily a bad thing. This is an area where we are highly trained and no other profession is comparable in that regard. And actually, if we really carved out that niche, we could conceivably be the supervisor of interdisciplinary treatment teams that include psychiatrists in addition to other clinicians. Perhaps, if we can work on advocating our role in this area, salary increase will not be far behind.

And as an aside, this transition makes sense because (despite what we would like to think) the research shows there is no difference in treatment outcomes based on years of education of the clinician. That is because (speaking from personal experience--I have a master's in counseling and am now in a clinical psych phd program) master's programs solely teach therapy theories and techniques, while psychology programs teach that plus a deep understanding of the human mind/behaviors (i.e., context) from multiple perspectives (e.g. medical, behavioral, interpersonal, etc.), as well as extensive training in the scientific method. This puts us in a unique position to fully understand the the patient's problems from multiple perspectives, determine the best treatment and develop a plan to carry it out. No other profession has the training to do that as successfully as psychologists.

I particularly agree with this point. I think the comparisons to other professionals are going to continue well into the future (they exist in other fields, and they'll likely continue to exist in ours); additionally, given that many non-psychologists don't always understand what it is our field actually does, we often have to compare ourselves to other mental health professionals to showcase our training and skills differences.

However, the administrative, supervisory, and program evaluation role is one that I definitely see psychologists continuing to move into. It just seems to naturally call for the skills we develop during grad school. Combine this administration with a spattering of individual patient assessments (if you're so inclined) and/or consulting work, and I'd imagine you could carve yourself out a nice little career.
 
From what I have learned, it seems psychologists will be more in the treatment planning and administrative role, rather than the actual clinicians carrying out treatment. It looks like psychologists will eventually be working in primary care settings as supervisors of master's level clinicians who are performing the actual therapy.

This is a large part of why I left my last place of employment. Yes, I can do all of those things, but I don't find them particularly fulfilling as primary responsibilities.

I actually like doing the treatment. It's why I became a psychologist.

(I'm not of the opinion that one should only become a psychologist if one wants to do research and/or assessment. I've worked with many masters-level clinicians and it's not my experience that they have the same depth of training, except for those who did extensive post-grad training.)
 
A psychiatrist graduates from medical school with an M.D (average cost of ($150,000) and spends 4 years in residency (with a pay of about $43,000 per yer). Thats a total of 12 yrs of training (4 yrs college, 4 medical school, 4 residency) and heck of alot of debt. We have licensing ability to manage medications. Psychologists and the therapy they provide play a critical role in the treatment of mental illness. So do medications.

Not all psychiatrists care to do talk therapy. And when they do, the training is available to them. I happily refer.

The assumption that all psychiatrists look down on psychologists is rather silly. If anything, we are compared to other physicians, not psychologists, and we are at the bottom of the totem pole in that regard.




See psychiatrists never say WE ARE BETTER AT TREATING THE CRAZY GUY! i dont understand where they get that from
 
^ Now now, is that any way to win friends here over on the psychology message boards?:rolleyes: While there may be some feelings of defensiveness on both sides, how do statements like this further a productive discussion?

I for one never wanted to be a psychiatrist, and I don't begrudge others who do. The job of psychologist is fundamentally different, and it suits some people better than others. Sure, I wish psychologists made more money, but I wouldn't trade jobs even for more money.

Let's move on...
 
I'm about to study Clinical Psychology at a university this fall but I'm wondering If I can switch to Psychiatry after those years in uni doing psychology and go to med school from there?

Is that possible?I'm really interested in mental health and I've researched both professions and they are quite similar besides the fact that one is a "doctor" and prescrive medicine while the other can't and has more of a therapy role.

After hearing basically a lot of similarities in the profession and time in school but 1/3-1/2 less pay is discouraging.
 
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