Psychology vs. Psychiatry

  • Thread starter Thread starter deleted276313
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

deleted276313

Members don't see this ad.
Yes, there is a reason why I'm posting this in the doctoral psych forum rather than the psychiatry forum or any other for that matter. I'm a psych major; I always have been and always plan to be. I absolutely love the field and I'm very strong in it.

In any case, I have gotten to the whole "Clinical Psych vs. Psychiatry" debate, and it's rather confusing. I like the idea of conducting therapy, psychological testing, and diagnosing. I do not agree with much of the medical model that revolves around psychiatry, or at least what I have experienced. That being said, I feel that because psychologists are not (for the most part) allowed to prescribe, that my job is somehow restricted in the area of full treatment for someone who has a chronic mental illness (schizophrenia, bipolar disorder, etc).

There are of course massive salary differences that also come into the debate as well (though don't pose as much of an "obstacle" to me), training differences, different specializations, and a myriad of other things that one has to consider.

In all, I'm more or less wondering what your opinions are between the pros and cons of either field.
 
Personally, I'm happy with my choice of clinical psychology over psychiatry based largely on the increased research experience and training, and the fact that my specialty (neuropsych) essentially requires psychological training. I also appreciate the in-depth education on theories and concepts of psychopathology and psychotherapy. As for prescribing, it helps to know that if I truly would ever want to go that route, I can just stay put here in Louisiana.

As for prescribing privileges more generally, and your statement in particular, keep in mind that psychology as a whole is generally becoming a much more specialized field, with practitioners making more efforts to carve out their own niches of competence. Thus, if you chose to work primarily with depressive and addictive disorders, for example, you likely wouldn't see many clients with severe mental illness; those who did come by would probably be referred to mental health workers who would be better able to treat them.

Then again, the specialization route is a lot easier to follow if you decide to go into private practice. When it comes to public mental health, you'll likely be exposed to the full gamut, regardless of your chosen specialty or method of training.
 
AcronymAllergy said:
As for prescribing privileges more generally, and your statement in particular, keep in mind that psychology as a whole is generally becoming a much more specialized field, with practitioners making more efforts to carve out their own niches of competence. Thus, if you chose to work primarily with depressive and addictive disorders, for example, you likely wouldn't see many clients with severe mental illness; those who did come by would probably be referred to mental health workers who would be better able to treat them.
Click to expand...

My main area of interest revolves around bipolar disorders (Bipolar I, Cyclothymia, etc) and psychotic disorders (Schizophrenia, Psychotic d/o NOS, etc).
 
Swamp56 said:
My main area of interest revolves around bipolar disorders (Bipolar I, Cyclothymia, etc) and psychotic disorders (Schizophrenia, Psychotic d/o NOS, etc).
Click to expand...

So yep, severe mental illness. Your treatment options would be somewhat limited, as there aren't yet many "talk" therapies that have been shown to be particularly effective in those populations (social skills training and behavioral therapy for substance abuse are the two that come to mind immediately). However, the research opportunities are nearly endless.

Although without prescribing privileges, you definitely would be, at the least, seeing those clients in tandem with a psychiatrist who is managing their medications. Unless you live in Louisiana or New Mexico, have your privileges, and also have access to the appropriate equipment to properly monitor anti-psychotic and mood-stabilizing pharmacological intervention.
 
The prescription authority movement is really growing. I suspect it will be a major issue in about 5 years or so. There are already several important government motions taking place for this.

We are losing psychiatrists like no tomorrow and fewer than 5% of all entering medical students actually go through the 8-10 years needed to specialize in psychiatry.

I too am caught in the struggle to decide between these clinical psych and psychiatry. While I am all for CBT and I believe in it as an effective treatment for a multitude of disorders. Sometimes it is not enough and patients could actually be benefitting from both CBT + medication treatment or a more brief form of CBT and medications. If I get into clinical psychology and get my degree, I would definitely try to get prescription authority as well.
 
deadmau5 said:
The prescription authority movement is really growing. I suspect it will be a major issue in about 5 years or so. There are already several important government motions taking place for this.

We are losing psychiatrists like no tomorrow and fewer than 5% of all entering medical students actually go through the 8-10 years needed to specialize in psychiatry.

I too am caught in the struggle to decide between these clinical psych and psychiatry. While I am all for CBT and I believe in it as an effective treatment for a multitude of disorders. Sometimes it is not enough and patients could actually be benefitting from both CBT + medication treatment or a more brief form of CBT and medications. If I get into clinical psychology and get my degree, I would definitely try to get prescription authority as well.
Click to expand...

I don't know the numbers, but I do know that many foreign-trained doctors end up going the psychiatry route in the US. I believe it, in part, has to do with the boarding process in psychiatry for international physicians being one of the easier ones available.

That being said, there are definite shortages of psychiatrists (especially in the public mental health care domain). It's one of the reasons so many states are currently considering legislation to grant psychologists prescription privileges.
 
My typical comments for Psychiatry v. Psychology are these:

1. A psychiatrist is a physician first, so if you do not enjoy medicine and everything that goes along with that, do not go for psychiatry.

2. A psychologist is a scientist first (or at least should be), so if you have an aversion to research (doing, using, etc), do not go for psychology because everything is trending towards EBTs and research is becoming more important.

3. Psychiatry is much broader than just meds management, however many of the most common jobs you see are for meds management.

4. Psychology is much broader than therapy and assessment, however many of the most common jobs are in those two areas.

5. Not all therapists are created equal. It is important to understand the benefits and drawbacks up each path as it relates to training in therapy and in other areas.

6. If you want to prescribe, the best path is either medical school or as a PA/NP. Prescribing psychology is a work in progress, so if your primary objective is to prescribe, psychology is not the most flexible nor easiest route.

There is more, but that is the general gist. If you want more information....do a search on SDN because there has been a plethora of threads on this exact topic.
 
deadmau5 said:
The prescription authority movement is really growing. I suspect it will be a major issue in about 5 years or so. There are already several important government motions taking place for this.

We are losing psychiatrists like no tomorrow and fewer than 5% of all entering medical students actually go through the 8-10 years needed to specialize in psychiatry.

I too am caught in the struggle to decide between these clinical psych and psychiatry. While I am all for CBT and I believe in it as an effective treatment for a multitude of disorders. Sometimes it is not enough and patients could actually be benefitting from both CBT + medication treatment or a more brief form of CBT and medications. If I get into clinical psychology and get my degree, I would definitely try to get prescription authority as well.
Click to expand...

For what it's worth, I am likely going to enter nursing school after receiving my PhD (heading to internship next year) and get my NP so that I can have both the therapy training from my PhD and be able to manage meds and also address and monitor physical health issues. It's an extra 2-3 years, but I feel like it sets me up well to treat people more holistically, the mind-body interaction and all that.

Not to mention it increases my employability, I think.
 
Therapist4Chnge said:
1. A psychiatrist is a physician first, so if you do not enjoy medicine and everything that goes along with that, do not go for psychiatry.
Click to expand...

And that's where I stop. At number one. :laugh: Somatic health does not interest me in the slightest and it never has. Not nutrition, not heart disease, not medicine, not...NONE of that by a mile. I've been forced to pay attention to nutrition and some autoimmune things within the past 3 years only because of a health condition, but it bores the heck out of me even though I have to rely on some knowledge/savvy to be able to eat. Lol.

So yeah. Medicine, no. I work at a psychiatric hospital (in a non-clinical role) and the times I encounter M.D.s, while there definitely is a huge knowledge base of psychological symptoms and prediction of progression etc...99% of it seems to revolve around how to use medications to regulate etc. I know this is imperative for some cases to stabilize, of course...it's just not what interests me in the slightest. What I care about is the mind, the emotions, the psychological suffering, what caused it, how it manifests in behavior and affects, how to treat and ease the suffering with...talk though, and therapy... not medicine..heh.

At the same time, I get where the OP is coming from. It seems like all roads lead to medication when one is having some kind of mental illness. So the patient/client may pass up the one that can't dish the meds. And there are some cases where it really is necessary, so it almost makes the psychologist seem pointless in that light. Maybe that's just a misconception I have, though, I'd be glad if it was. There do also seem to be people out there who are strongly against getting on a medication regimen with regards to mental health. Not just the stigma, but the whole 'once-you-go-on-you-can-never-go-off" and how it might change what someone feels is an identifiable part of their personality...etc... Anyway what T4C said for 3 and 4 might be the answer to that dilemma.

Anyway, hands down, I would not be happy with psychiatry as my job. Psychiatry before any OTHER kind of medical doctor...but...otherwise, no.
 
That's an interesting combination - I think you're the first person I've heard of who is doing that. Where are you planning to look for employment and how will your two degrees be integrated? I don't know much about NP - are you allowed to hold a private practice as a clinical psychologist and then provide meds as a NP?

Psycycle said:
For what it's worth, I am likely going to enter nursing school after receiving my PhD (heading to internship next year) and get my NP so that I can have both the therapy training from my PhD and be able to manage meds and also address and monitor physical health issues. It's an extra 2-3 years, but I feel like it sets me up well to treat people more holistically, the mind-body interaction and all that.

Not to mention it increases my employability, I think.
Click to expand...
 
robinsena said:
That's an interesting combination - I think you're the first person I've heard of who is doing that. Where are you planning to look for employment and how will your two degrees be integrated? I don't know much about NP - are you allowed to hold a private practice as a clinical psychologist and then provide meds as a NP?
Click to expand...

I could be very, very wrong, but I believe NP's require some type of physician supervision for prescription writing. Heck, in Louisiana, prescribing psychologists do as well in a way (need to coordinate with the PCP, and after XX number of months have a physician or three sign off on your ability to prescribe competently).
 
robinsena said:
That's an interesting combination - I think you're the first person I've heard of who is doing that. Where are you planning to look for employment and how will your two degrees be integrated? I don't know much about NP - are you allowed to hold a private practice as a clinical psychologist and then provide meds as a NP?
Click to expand...

There's someone on here who has done it and gave me a lot of good advice, and there's someone in my city who also did it and we had a long conversation about the process. I think that if you work for a hospital or something like that, that you work in one official role or the other, but your skills & training allow you to handle things that one or the other job wouldn't allow you to be able to do.

My ultimate goal would be to be part of one of these groups of mental health professionals who band together in a private practice and do about 1/2 med management and 1/2 therapy.

AcronymAllergy said:
I could be very, very wrong, but I believe NP's require some type of physician supervision for prescription writing. Heck, in Louisiana, prescribing psychologists do as well in a way (need to coordinate with the PCP, and after XX number of months have a physician or three sign off on your ability to prescribe competently).
Click to expand...

It depends on the state how much a physician has to do oversight. I would expect that to be part of the deal, though. The NP/psychologist that I spoke with said that he has to meet with a physician like once every three months or something like that for supervision. I'm still at the beginning stages of this, though so I'm no expert but both people said it was completely worth it, both workwise and financially.
 
Psycycle said:
There's someone on here who has done it and gave me a lot of good advice, and there's someone in my city who also did it and we had a long conversation about the process. I think that if you work for a hospital or something like that, that you work in one official role or the other, but your skills & training allow you to handle things that one or the other job wouldn't allow you to be able to do.

My ultimate goal would be to be part of one of these groups of mental health professionals who band together in a private practice and do about 1/2 med management and 1/2 therapy.



It depends on the state how much a physician has to do oversight. I would expect that to be part of the deal, though. The NP/psychologist that I spoke with said that he has to meet with a physician like once every three months or something like that for supervision. I'm still at the beginning stages of this, though so I'm no expert but both people said it was completely worth it, both workwise and financially.
Click to expand...

It is entirely worth it. The hard part is getting the BSN to become a RN which you need before becoming a NP. I had to take a leave of absence from everything to get the BSN (accelerated program, 16 months full-time). But the psych NP was easy to complete with my background as a psychologist, and I am very glad I took the plunge and did it.

NPs have full independence in 14 states and in most of the others can practice independently within a collaborative agreement with a physician in the same specialty area. Only a handful (3 or so) still require physician supervision. My state is fully independent; I am in private practice and provide therapy, meds, testing, consultation, etc. on my own with no physician involvement.
 
Last edited:
Thanks for the info. It does sound rewarding and intriguing. Unfortunately, since I hate chemistry and biology, I don't think I'll even be able to pass the prereqs for a BSN. :laugh: But if I personally had to choose who to consult if I had a mental health issue that required meds, I would totally prefer someone with training in psychology than someone who is only aware of (or only endorses) the biological model of mental disorders. 👍
 
medium rare said:
It is entirely worth it. The hard part is getting the BSN to become a RN which you need before becoming a NP. I had to take a leave of absence from everything to get the BSN (accelerated program, 16 months full-time). But the psych NP was easy to complete with my background as a psychologist, and I am very glad I took the plunge and did it.

NPs have full independence in 14 states and in most of the others can practice independently within a collaborative agreement with a physician in the same specialty area. Only a handful (3 or so) still require physician supervision. My state is fully independent; I am in private practice and provide therapy, meds, testing, consultation, etc. on my own with no physician involvement.
Click to expand...

Thanks again for all of your fantastic advice on here. I wasn't sure if it was ok to put your name in the thread, and I'm glad that you found it! I am likely going to pursue the NP before pursing my psychologist license, going to an accelerated BSN program right after finishing my internship, and then the NP program. I'm hoping to get the supervised hours in psychology as I practice as an NP...is that realistic do you think? I'd take the EPPP as I get the prereqs for the BSN program out of the way, and probably also start my family in that time...seems like it would work out scheduling wise. My goal is to do exactly what you're doing, to have a private practice where I can provide some basic testing, therapy, meds, and consultation. I've been getting so much feedback from people who have been in the psychiatric system about the frustration they experience having to see 2 providers for meds and therapy, and I would love to alleviate some of that.

robinsena said:
Thanks for the info. It does sound rewarding and intriguing. Unfortunately, since I hate chemistry and biology, I don't think I'll even be able to pass the prereqs for a BSN. :laugh: But if I personally had to choose who to consult if I had a mental health issue that required meds, I would totally prefer someone with training in psychology than someone who is only aware of (or only endorses) the biological model of mental disorders. 👍
Click to expand...
Yeah, I love biology but organic chemistry was a tough one. I hope that there's not too much of that - regular chem I can handle, but when we get into organic territory I get terrified! I too would rather send someone to a practitioner who can step outside of the medical model and work as a psychologist. I think that the difficulty of therapy is extremely understated, too, and there are far too many people out there who are practicing therapy without the appropriate training.
 
medium rare said:
It is entirely worth it. The hard part is getting the BSN to become a RN which you need before becoming a NP. I had to take a leave of absence from everything to get the BSN (accelerated program, 16 months full-time). But the psych NP was easy to complete with my background as a psychologist, and I am very glad I took the plunge and did it.
Click to expand...

Out of curiousity, what type of training is after the BSN that bumps you up to psych NP. I assume that's where the majority of psychophaerm training takes place? What other training is invloved at that stage? How long did it take you to recoop the lost income from taking 2 years off? I assume your income has gone up markedly since doing this?
 
Psycycle said:
Thanks again for all of your fantastic advice on here. I wasn't sure if it was ok to put your name in the thread, and I'm glad that you found it! I am likely going to pursue the NP before pursing my psychologist license, going to an accelerated BSN program right after finishing my internship, and then the NP program. I'm hoping to get the supervised hours in psychology as I practice as an NP...is that realistic do you think? I'd take the EPPP as I get the prereqs for the BSN program out of the way, and probably also start my family in that time...seems like it would work out scheduling wise. My goal is to do exactly what you're doing, to have a private practice where I can provide some basic testing, therapy, meds, and consultation. I've been getting so much feedback from people who have been in the psychiatric system about the frustration they experience having to see 2 providers for meds and therapy, and I would love to alleviate some of that.
Click to expand...

That is quite realistic and a good plan. You can be working, for example, as a psych NP in a CMHC, and as long as there is a licensed psychologist willing to supervise you, you can have your hours count towards psychology licensure.
 
In our managed care, third party payment world, it's about what you do that no one else can do.

Psychiatrists can prescribe and get paid an arm and a leg to do med management. Can they do talk therapy? Yes, but outside of private practice, I don’t see a hospital paying a Psychiatrist $120k+ to do something an LPC will do for $40k.

Psychologists can uniquely do testing (going along with that scientist first) and they are paid… oh just the arm to do that 😛. Hospitals will also hire them as consultants and chiefs of mental health. You could also do medical science laison, but MDs can do that too. Outside of private practice, I don’t see too many psychologists doing counseling, however I see more than psychiatrists to be sure.

So really, do psychologists NEED prescription power? Maybe, I'm not against it. However, they already do something a psychiatrist can’t or won’t do… testing (I’ll understand if that’s of little consolation).
 
erg923 said:
Out of curiousity, what type of training is after the BSN that bumps you up to psych NP. I assume that's where the majority of psychophaerm training takes place? What other training is invloved at that stage? How long did it take you to recoop the lost income from taking 2 years off? I assume your income has gone up markedly since doing this?
Click to expand...

After you get the BSN, you have to get a MSN (Master of Science in Nursing) in the specialty area as a psychiatric/mental health nurse practitioner. The training is specialized for mental health, but you also have to complete core requirements for basic NP training (advanced health and physical assessment, advanced pathophysiology, advanced pharmacology,and a bunch of nursing theory courses that are largely BS). You also have to take psychopharmacology, neuropathophysiology, and clinical practica in addition to basic diagnostic, assessment, and therapy courses.

After getting, the MSN, you have to qualify to take the board-certification exam administered by ANCC as either an adult or family psychiatric/mental health NP (family certification allows you to see children and adolescents). After passing the boards, you can then apply for certification or licensure in you state as an Advanced Practice Nurse (APN) (of which NPs are one type) in your specialty area. The 4 main categories of APNs are: NPs, CRNAs (Certified Registered Nurse Anesthetists), CNMs (Certified Nurse Midwifes), and CNSs (Clinical Nurse Specialists).

Once I was certified as a psych NP, it took me about 9 months to recuperate the money I invested in NP training (BSN & MSN) through my private practice. The money is very good and my practice is bursting at the seams.
 
medium rare said:
Once I was certified as a psych NP, it took me about 9 months to recuperate the money I invested in NP training (BSN & MSN) through my private practice. The money is very good and my practice is bursting at the seams.
Click to expand...
I considered this route, and while it is still an option, taking the classes for the RN seems like such a long road. I formerly tutored nursing students in some of the hard science stuff, and the nursing theory was just not my bag. The money is pretty attractive though.
 
medium rare said:
Once I was certified as a psych NP, it took me about 9 months to recuperate the money I invested in NP training (BSN & MSN) through my private practice. The money is very good and my practice is bursting at the seams.
Click to expand...

wow. Ok. thats quick. How did you reestablish patients load and referral base/flow so quickly since you were out of the loop for what... over 3 years? Was your practice just "waiting in the wings" so to speak, or did you have to build it up agian?
 
erg923 said:
wow. Ok. thats quick. How did you reestablish patients load and referral base/flow so quickly since you were out of the loop for what... over 3 years? Was your practice just "waiting in the wings" so to speak, or did you have to build it up agian?
Click to expand...

I was only completely "out of the loop" for the 16 months it took to get the BSN. I was able to still practice 2 days/week while I got the MSN.

I had several patients continue when I resumed private practice full-time, but, once I got a prescription pad, the referrals came out of the woodwork. Seriously, I made less than 6 phone calls to other psychologists I already knew who were in private practice and had lunch with 1 pediatrician and 1 internist, and my phone began to ring. Within a month I was getting 2 - 5 calls/day from potential new patients. I had planned on doing some serious marketing to get myself going again, but I never got the chance because I was inundated with referrals so quickly - fine with me; I saved a ton on advertising/marketing expenses.

BTW, I don't take insurance. Cash-and-carry only.
 
Therapist4Chnge said:
I considered this route, and while it is still an option, taking the classes for the RN seems like such a long road. I formerly tutored nursing students in some of the hard science stuff, and the nursing theory was just not my bag. The money is pretty attractive though.
Click to expand...

It can be a bitch, I won't lie. My 7th hour of a 12-hour OB/GYN shift with three scheduled c-sections and a VBAC (vaginal birth after cessarian) 6 cm dilated OP (occipital posterior) i.e.- the mother is in pain, had me asking myself, "How the hell did I get here?". And, nurses are notorious for 'eating their young.'

However, it was just over a year and, in the end, it has been well worth it to put up with floor nursing in order to eventually get Rx authority.

Though there were days I was ready to throw in the towel.
 
medium rare said:
It can be a bitch, I won't lie. My 7th hour of a 12-hour OB/GYN shift with three scheduled c-sections and a VBAC (vaginal birth after cessarian) 6 cm dilated OP (occipital posterior) i.e.- the mother is in pain, had me asking myself, "How the hell did I get here?". And, nurses are notorious for 'eating their young.'

However, it was just over a year and, in the end, it has been well worth it to put up with floor nursing in order to eventually get Rx authority.

Though there were days I was ready to throw in the towel.
Click to expand...
This was actually my biggest concern. A good friend is an RN (about to be licensed as an NP) and hearing her stories gave me pause. I've worked with some great RNs, but I've also seen some wicked backstabbing. Most likely I'll just stick with my neuro work, but if I get the itch maybe I'll go back.
 
Therapist4Chnge said:
This was actually my biggest concern. A good friend is an RN (about to be licensed as an NP) and hearing her stories gave me pause. I've worked with some great RNs, but I've also seen some wicked backstabbing. Most likely I'll just stick with my neuro work, but if I get the itch maybe I'll go back.
Click to expand...

Most of the women in my family are RNs or NPs, and I gotta say, the stories I hear about regularly re:backstabbing and jealousy are scary.
 
medium rare said:
That is quite realistic and a good plan. You can be working, for example, as a psych NP in a CMHC, and as long as there is a licensed psychologist willing to supervise you, you can have your hours count towards psychology licensure.
Click to expand...

Oh, great. Thanks again so much. This would work out, I hope that I can get the EPPP done the same time I take the prereqs, and then it should all even out and eventually I will stop being a student and have a career!

medium rare said:
It can be a bitch, I won't lie. My 7th hour of a 12-hour OB/GYN shift with three scheduled c-sections and a VBAC (vaginal birth after cessarian) 6 cm dilated OP (occipital posterior) i.e.- the mother is in pain, had me asking myself, "How the hell did I get here?". And, nurses are notorious for 'eating their young.'

However, it was just over a year and, in the end, it has been well worth it to put up with floor nursing in order to eventually get Rx authority.

Though there were days I was ready to throw in the towel.
Click to expand...
Yes... that part I am dreading - not so much the medical stuff because I love that and the nursing actually fills another desire of mine which is to know more about physical health, but I am dreading how evil nurses can be. My sister and mother are both nurses and I have heard some serious stories about how nursing school can be. But I'll keep in mind, it's just a year.
 
Haha, it's great how those of us who have friends and relatives in the nursing field have all heard consistently how stressful that field can be. My mother is a nurse and I remember her talking about how variable nurses can be in terms of their commitment to their jobs and the way they treat their co-workers. But then again, these issues exist in every job - maybe it's the combination of being in primary care under the 'authority' of doctors that makes RNs even more stressed out. 🙄
 
robinsena said:
Haha, it's great how those of us who have friends and relatives in the nursing field have all heard consistently how stressful that field can be. My mother is a nurse and I remember her talking about how variable nurses can be in terms of their commitment to their jobs and the way they treat their co-workers. But then again, these issues exist in every job - maybe it's the combination of being in primary care under the 'authority' of doctors that makes RNs even more stressed out. 🙄
Click to expand...

Not to get too far into the nursing subject but yes I definitely agree with that. Part of me thinks that some nurses feel undervalued, especially when they are constantly in the trenches doing a lot of the invaluable dirty work; then at the end of the day they make a fraction of what the MD does.
 
phillydave said:
Not to get too far into the nursing subject but yes I definitely agree with that. Part of me thinks that some nurses feel undervalued, especially when they are constantly in the trenches doing a lot of the invaluable dirty work; then at the end of the day they make a fraction of what the MD does.
Click to expand...

This is very true. They handle most of the patient contact and all of the day to day tasks. The nurses here are invaluable for information and also help me get in to see patients so I don't waste my time traveling to the various units when patients are otherwise unavailable.
 
Interesting thread. I've volunteered in a state mental hospital for about nine months now. Love it. Many of the clients I work with in the psychosocial program have schizophrenia. I would say there is actually a big need for counselors for them. They get to see a psychiatrist for about 15 minutes a week mostly for meds and quick status check. I've been lucky enough to sit in on some of these sessions, plus from the group work I get to do, I can say I really see where many of the clients would benefit from actual counseling as well. This being a state hospital maybe the funding just isn't there, but the need is.

Also interesting about the nursing issue, I once worked in a female dominated profession and just do not have a desire to work in one again. I was willing to go the NP route, suck it up for a few years, but as I've posted in the past with the need to earn a living, take care of kids, etc., that won't be in my cards. But I'm starting to think it may be for the best:laugh:
 
Therapist4Chnge said:
This is very true. They handle most of the patient contact and all of the day to day tasks. The nurses here are invaluable for information and also help me get in to see patients so I don't waste my time traveling to the various units when patients are otherwise unavailable.
Click to expand...

They certainly work hard for the money they earn. My mom's a veteran RN, works in oncology, and probably makes around what the average licensed psychologist makes, but holy cow, I'll say it a thousand times over, I couldn't ever do what they do from day to day.
 
Therapist4Chnge said:
My typical comments for Psychiatry v. Psychology are these:

1. A psychiatrist is a physician first, so if you do not enjoy medicine and everything that goes along with that, do not go for psychiatry.

2. A psychologist is a scientist first (or at least should be), so if you have an aversion to research (doing, using, etc), do not go for psychology because everything is trending towards EBTs and research is becoming more important.

3. Psychiatry is much broader than just meds management, however many of the most common jobs you see are for meds management.

4. Psychology is much broader than therapy and assessment, however many of the most common jobs are in those two areas.

5. Not all therapists are created equal. It is important to understand the benefits and drawbacks up each path as it relates to training in therapy and in other areas.

6. If you want to prescribe, the best path is either medical school or as a PA/NP. Prescribing psychology is a work in progress, so if your primary objective is to prescribe, psychology is not the most flexible nor easiest route.

There is more, but that is the general gist. If you want more information....do a search on SDN because there has been a plethora of threads on this exact topic.
Click to expand...

If psychology is more about research and psychiatry more about med management than what is more about psychotherapy?
 
Therapist4Chnge said:
My typical comments for Psychiatry v. Psychology are these:

1. A psychiatrist is a physician first, so if you do not enjoy medicine and everything that goes along with that, do not go for psychiatry.

2. A psychologist is a scientist first (or at least should be), so if you have an aversion to research (doing, using, etc), do not go for psychology because everything is trending towards EBTs and research is becoming more important.

3. Psychiatry is much broader than just meds management, however many of the most common jobs you see are for meds management.

4. Psychology is much broader than therapy and assessment, however many of the most common jobs are in those two areas.

5. Not all therapists are created equal. It is important to understand the benefits and drawbacks up each path as it relates to training in therapy and in other areas.

6. If you want to prescribe, the best path is either medical school or as a PA/NP. Prescribing psychology is a work in progress, so if your primary objective is to prescribe, psychology is not the most flexible nor easiest route.

There is more, but that is the general gist. If you want more information....do a search on SDN because there has been a plethora of threads on this exact topic.
Click to expand...


We need quality M.D.'s who want to practice psychiatry as an art based upon science since a huge proportion of psychiatrists I know and have read are NOT practicing for the correct reasons. I think if someone really enjoys medicine and helping the metally ill then psychiatry may be appropriate, so as long as it is not for more dubious reasons like being afraid of blood or not being able to remember the bones.

I would add that psychology is as much an art as a science and a practitioner or clinician within psychology needs to apply the science in appropriate but unique ways.
 
phillydave said:
Not to get too far into the nursing subject but yes I definitely agree with that. Part of me thinks that some nurses feel undervalued, especially when they are constantly in the trenches doing a lot of the invaluable dirty work; then at the end of the day they make a fraction of what the MD does.
Click to expand...
There are plenty of nurses and psychologists who teach courses in medical school. An experienced nurse teaches interns and residents plenty!
 
Each discipline has more time devoted to specific skills. As a psychiatry resident I plan to prioritize psychotherapy in my career. But we do often do a great deal of medication management.

As for alternate paths to prescribing meds, I'm finishing up a 4-year training at one of the premier institutes in psychopharmacology in the country, and I am painfully aware of how complex it all is. Being supervised by a PCP is nowhere near sufficient because I can't tell you how many PCP's don't understand psychiatric meds, or how psychiatric meds interact with other meds or other medical conditions. Medical conditions can mimic mental illness, and vice versa. Polypharmacy can be a mess. Contrary to the pro-psychologist's prescribing propaganda movement, giving out psychiatric meds is not simple, doesn't improve access, and is just opening up room for more medical errors. Psychologists don't get sued much, and after working at many hospitals and clinics, just because no one is watching or supervising you and calling fouls, that doesn't mean you're doing a good job. It just means no one is catching your mistakes.

For chronic and severe mental illnesses, I've definitely seen therapy be helpful. So if that's what resonates for you, do it. I was a psychology major as well, but I moved into medicine because I liked science and wanted to understand and be able to treat the whole person, not just their mind.

There's pro's/con's to each. I think PCP's/NP's/PA's prescribing is good and can be helpful in simple cases of psychiatric illness. I think complex cases, which many many are, challenges even the best psychiatrists.

On the flip side there's many psychiatrists out there who're utterly unskilled at any level of therapy. There was a period of time where that wasn't a mandated part of training. Right now the pendulum is swinging back to increasing amounts of therapy training, in addition to pharmacology.

I love my field. I wouldn't have done anything differently.
 
I teach residents and know that nobody is more confused by their field than a resident full of information and lacking experience. Yes it is a bit complicated, but nowhere near as complicated as internal medicine, surgery or even family medicine. It gets much easier with time.
 
What's all this talk about nurses and backstabbing and all that? Is it just an exaggerated account of the different ways men and women express hostility at work (spreading rumors as opposed to more direct confrontation)? Or is there more to it?

I mean you get your narcissistic overly competitive people in any profession. In fact school and training attract people who love competition. That's probably common to all high-stress professions that require more people interaction from medicine and nursing to psychology and social work.
 
ClinPsycMasters said:
What's all this talk about nurses and backstabbing and all that? Is it just an exaggerated account of the different ways men and women express hostility at work (spreading rumors as opposed to more direct confrontation)? Or is there more to it?
Click to expand...

Obviously this does not apply to everyone in the profession, though I have seen a greater tendency for relational aggression within the nursing field. Back room talks about problems instead of direct confrontation of the person, targeting relationships to isolate people who do not conform, the establishment of "In" and "Out" groups, etc.
 
stigmata said:
I teach residents and know that nobody is more confused by their field than a resident full of information and lacking experience. Yes it is a bit complicated, but nowhere near as complicated as internal medicine, surgery or even family medicine. It gets much easier with time.
Click to expand...

I'm a chief resident, and have a reasonable body of experience at this point, thanks.

More dangerous I think is hubris and false confidence.
 
Therapist4Chnge said:
Obviously this does not apply to everyone in the profession, though I have seen a greater tendency for relational aggression within the nursing field. Back room talks about problems instead of direct confrontation of the person, targeting relationships to isolate people who do not conform, the establishment of "In" and "Out" groups, etc.
Click to expand...

Well, darn it, that describes my current job. I deal with a bunch secretaries all the time--I do some secretarial duties as well as research and clinical work. It's a very confusing situation with power struggles and role confusion (research, clinical, admin) and I've recently just about given up trying to figure out all the office politics. It's impossible to be on top of it all. I used to, believe it or not, actually spend time strategizing my battle plan. It's inevitable that someone starts complaining about something and the beautiful thing is they never do it to my face. So I always hear a distorted message that is never traceable to the original source and even if it were, it'd usually get denied. Okay, glad I got that off my chest. Phewwww.
 
nitemagi said:
Each discipline has more time devoted to specific skills. As a psychiatry resident I plan to prioritize psychotherapy in my career. But we do often do a great deal of medication management.

As for alternate paths to prescribing meds, I'm finishing up a 4-year training at one of the premier institutes in psychopharmacology in the country, and I am painfully aware of how complex it all is. Being supervised by a PCP is nowhere near sufficient because I can't tell you how many PCP's don't understand psychiatric meds, or how psychiatric meds interact with other meds or other medical conditions. Medical conditions can mimic mental illness, and vice versa. Polypharmacy can be a mess. Contrary to the pro-psychologist's prescribing propaganda movement, giving out psychiatric meds is not simple, doesn't improve access, and is just opening up room for more medical errors. Psychologists don't get sued much, and after working at many hospitals and clinics, just because no one is watching or supervising you and calling fouls, that doesn't mean you're doing a good job. It just means no one is catching your mistakes.

For chronic and severe mental illnesses, I've definitely seen therapy be helpful. So if that's what resonates for you, do it. I was a psychology major as well, but I moved into medicine because I liked science and wanted to understand and be able to treat the whole person, not just their mind.

There's pro's/con's to each. I think PCP's/NP's/PA's prescribing is good and can be helpful in simple cases of psychiatric illness. I think complex cases, which many many are, challenges even the best psychiatrists.

On the flip side there's many psychiatrists out there who're utterly unskilled at any level of therapy. There was a period of time where that wasn't a mandated part of training. Right now the pendulum is swinging back to increasing amounts of therapy training, in addition to pharmacology.

I love my field. I wouldn't have done anything differently.
Click to expand...

Not to mention all those psychiatrists who do not understand psychopharmacology either. I met countless psychiatrists who did not know several potentially fatal drug interactions, undertand substance P, many real and emprically validated side effects of drugs they were prescribing, what ethyl methyl ketones were, what the signs and causes of horner syndrome were, (the anhydrosis is parasympathetic related) how to read the basic spacing in an EKG, how to interpret Harrison's at all, and certainly they did not offer any real psychotherapy... I thank you for caring about your profession, I commend you for having a psychology background, I appreciate your candor, and I hope that you help those cleints you work with.

I chose those seemingly unrelated signs and medical issues for several reasons and not just direct drug topics but I included several of those too.

Having said all of that, I must say that if one is dedicated to understanding the biochemical basis of pharmacology in general and specifically the biochemical basis of neuropharmacology, then they are off to a great start; there is no reason why a competent psychologist with focus cannot get the appropriate post-doctoral training to prescribe meds... think of it this way: most attending physicians and psychiatrists no next to nothing about the new drugs coming out now for these reasons: most cannot interpret the stats or the biochemistry in the industry provided lit, the meds are too new so there are unknown side effects not yet revealed and the doctors are usually so busy that they do not take the time to really get to know what they do not know about the drugs and instead heavily rely upon the pharmaceutical rep for information. Ofcourse the psychologist too needs undergrad biochemistry and psychopharmacology too.

Now some doctors and a small % of those who become psychiatrists do so with the care, detachment but focused passion necessary, however, the biochemistry taught in med school is not too good and so, if they do not recall undergrad biochem and little organic chem those pharmacology courses lack some context. Most first year to 3rd year attendings know less nowadays than a good resident, however, residency needs to be carefully crafted to maximize the resident's education...
 
Last edited:
Gen Chem I and II, Organic I and II, biochem, general pharmacology, 4 biology courses, 6-8 psychology courses, general stats, advanced stats, (or stats I upper division) pre-calc and atleast Calc I, and all the usual liber arts and gen ed/electives for the first 4 years of school. Then either a good masters, PhD, or M.D. program thereafter. Then when the post doctoral training for prescribing comes it is actually easy to get through at that point... just a little more study, review and oversite... that is if one does well in the undergrad and grad programs as well.
 
Therapist4Chnge said:
MOD NOTE: I don't want this to turn into an RxP debate....we have a thread for that up top already. Let's get back to the topic at hand. -t4c
Click to expand...

Back to the subject at hand. If you really want to understand the science of behavior go with psychology. If you want to prescribe medication and provide good short term talk therapy go with psychiatry.
 
Last edited:
You will learn 10 times more in your first 5 years of real-world practice than you did in residency.
 
I was in no way trying to start a flame war. Just trying to make a distinction that the illusion of getting adequate training in medications and therapy during the routine post-graduate training is ludicrous. Psychiatrists get grossly undertrained in therapy during residency, and I believe anyone serious in it needs additional training beyond our 4 years of residency. Some programs are of course better than others.

The other side is that pretending that a short 1-2 year program in pharmacology is equivalent to 4 years of medical school and 4 years of training is equally ludicrous. As PsychGraduate points out, many many psychiatrists make medical errors all the time, so imagining that you can really do it all effectively as a psychologist I believe is misguided.

My perspective is that psychiatry offers more flexibility. There are outstanding psychiatrists that're therapists out there. If you're smart, dedicated, (as opposed to many people who got into psychiatry because it's less competitive or considered a lifestyle specialty), you can become great at the medical side of mental illness as well. But going into psychiatry and being excellent at therapy if that's your priority is a much longer road, involving additional training, and in some cases unlearning much of the personality structure ground into us through medical indoctrination. I'm happily self-aware and resistant to such indoctrination 😀

Our fields have constant turf wars. I'm not trying to add more. I prefer to continue dialogue.
 
stigmata said:
You will learn 10 times more in your first 5 years of real-world practice than you did in residency.
Click to expand...

I'd say that depends on the residency, and depends on the "real-world practice." I've been moonlighting at multiple sites - in jails, a private hospital, a county psychiatric hospital, in addition to my residency training of an outpatient clinic that serves simultaneously unfunded chronically mentally ill and insured higher functioning, an academic hospital serving a diverse base of funded and unfunded again, and one of the best VA hospitals in the country. My clinical exposure is quite broad, actually.

And my point again and again is that despite all this I'm still aware that I do not know everything, and I believe we should all hold that level of humility regardless how many years out of your grad school or post-doc you are.

One area of my academic research is in psychosomatic medicine. Data can be fairly spotty as to medical causes of psychiatric illness, not because there isn't epidemiological data out there, but because it's based on what has been looked for. We can't really know the prevalence unless we take a group and thoroughly work them all up. Otherwise we'll never know how much we miss.

False confidence comes from us never being challenged, and so assuming we're right. That doesn't make it so. I'm a clinician that aims for critical evaluation all the time. Which is tough with mental illness, where little is known as it is.
 
Jon Snow said:
This, I also agree with, though as/more competent than a psychiatric nurse/nurse practitioner may be attainable. Certainly, psychologists have something to offer with their diagnostic skills in this regard that nurses and physicians do not necessarily possess.

I'm not sure I agree about greater flexibility. Psychology is a very diverse field. Flexibility has never been a problem. I think the biggest advantage for psychiatry is more easily accessible good money potential. The medical school training would also be interesting to have (though expensive).
Click to expand...

I think the differences in training are substantial. Medicine is unique in many aspects, as is psychology. For me a substantial difference is overnight call. Besides the time spent seeing patients in emergency room settings and the sheer hours logged of patient time isn't matched in any of mental health practice. 30-hour shifts once a week during the first year alone is 1500 hours of patient time, dealing with emergencies that just don't come up in outpatient practice. Therefore I could make the argument that psychiatrists are better trained at dealing with mental health emergencies, in a way different than say staffing a crisis hotline. But again there's variation between residency programs as well.
 
You must log in or register to reply here.

Similar threads

The Cinnabon
Clinical Psychology vs. MD/PhD Psychiatry
Replies
32
Views
5K
borne_before
borne_before
R
Pop Psychology
Replies
6
Views
981
Sanman
Sanman
S
Duquesne University Clinical Psychology PhD
Replies
5
Views
2K
sb1129
S
C
Clinical PsyD vs Clinical psychology PhD
Replies
7
Views
3K
cytomegalovirus123
C
J
PhD/PsyD USUHS Clinical Psychology 2026
Replies
0
Views
1K
JRM96
J
Top