Psychiatry or Clinical Psychology?

Interesting. Most folks who post this kind of thing seem pretty blatantly either better suited for medicine or psychology. You make a good case for being on the fence.

The Everglow said:

If I do a PhD, I get to learn a lot about psychological theory which really fascinates me. Obviously clinical psychologists get plenty of therapy training which is awesome. But on the down side I'd have to do a lot of research to get there, which, as I mentioned, I have some, but not an overwhelming, interest in.

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Defer to a psychologist on this one.

The Everglow said:

To do an MD, I have to wade through medical school. I'm not super interested in some other areas of medicine, like OBG, peds etc. However, I'm fascinated by endocrinology, psychosomatic medicine and pharmacology. Nonetheless, it seems daunting.

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It is daunting. Even if you can't imagine not going to med school, it's still kind of a kick in the balls sometimes. Hourly for weeks, sometimes.

My question would be this: when you say you're "fascinated by endocrinology, psychomatic medicine, and pharmacology", are you speaking strictly as it relates to mental illness? Or do you find endocrinology as it relates to non-psych conditions and non-psych pharmacology interesting?

If you do, medicine should be a strong contender. If you just find the medicine that has to do with mental health interesting, you might be better served going the psychologist route. Lots of psychologists do neuropsych fellowships and whatnot. Many have an impressive knowledge of anatomy, endocrinology, etc. Becoming a psychologist doesn't mean you have to stop learning about any of the things you're claiming interest in now.

But if you are just interested in pharm/endo/etc. only as it relates to mental health, you'll quickly learn that the psych component of medical school is a very small piece of the pie. If you're not interested in medicine in general and psych in specific, I'm not sure a career in medicine is the best choice.

The Everglow said:

Furthermore, and correct me if I'm wrong, psychiatrists get much less therapy and psychological theory training.

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Boy, that's a loaded topic around here. A lot of folks seem to argue that psychiatry training programs spend as much time on training in psychotherapy and psychological theory training as psychology PhD's, but that smacks of "sweet lemons" to me. I'm a resident at a program that has the reputation for leaning much more towards the psychological end of the psychotherapy---biological spectrum, and I still find a health mix of the two. If psychology PhD's don't get as much actual psychological theory and psychotherapy training as your average psychiatrist does in four years (which is training in addition to general medical training and psychopharm), then I really wonder what those PhD's are doing with their time. But again, others will have different ideas.

The Everglow said:

From what I understand, you guys focus heavily on the biomedical model, which I am interested in, but at the same time, I don't want to miss out on the "psychology" of mental illness.

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I can't imagine any decent residency missing out on the "psychology of mental illness." I interviewed at a program that's known for being very biologically focused and it still had a health psychology emphasis.

I think the real question is really going to be whether or not you want to be a physician who works in mental health or a psychologist who works in mental health. If you don't have a healthy passion for medicine (in general), I'd be pretty reluctant to recommend becoming a doctor of any stripe.

Hope this helps and good luck with your decision. You sound like a smart, insightful person. And you're going about your decision the right way. I'm sure you'll be happy whichever path you end up goin down.

The Everglow said:

To do an MD, I have to wade through medical school. I'm not super interested in some other areas of medicine, like OBG, peds etc. However, I'm fascinated by endocrinology, psychosomatic medicine and pharmacology. Nonetheless, it seems daunting. Furthermore, and correct me if I'm wrong, psychiatrists get much less therapy and psychological theory training. From what I understand, you guys focus heavily on the biomedical model, which I am interested in, but at the same time, I don't want to miss out on the "psychology" of mental illness.

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Nobody is super interested in every aspect of medicine. If you're super interested in more than one aspect of medicine, then I think medical school should be a good option for you.

I'm not sure that you will miss out on the "psychology" of mental illness if you go through medical school. You're free to read as much psychological theory as you like, if you have an interest. Psychological literature on mental illness is not inaccessible to psychiatrists, after all.

Will you be as good a therapist as a psychiatrist as you would if you became a psychiatrist? Tough to say, but ultimately you'll get good at what you do. If you spend your days doing therapy and following literature on therapy, then you'll get good at it. Likewise if you spend your time reading about the molecular aspects of mental illness, you'll get good at that too.

Many of your areas of interest are worked in by both, especially in research venues. Psychologists dominate, just by the sheer numbers of them, and there is a hunger for psychiatrists to do psychosomatic work and research. Look at psychosomatic.org, for example.

Medical school is a frack-load of work. And you most definitely won't get jazzed about everything (my ob/gyn experience I counted the minutes).

If I were in your shoes, I would think longitudinally - Psychologists work hard for less money, have more competition after training, and can't get much medical training easily without a lot of fellowships. It's a lot easier (and wanted by others) to get extra therapy training as an MD.

As my sig states, though, there's more than one way to the top...

I just made the same decision and opted for medical school - I definitely want to practice psychotherapy, but I am also extremely interested in psychopharm and want to be able to manage medications in complex patients. And when I think about the training, I know I'd rather spend the next few years learning medicine as opposed to psych theory and non-psychotherapy psych.

The Everglow said:

I am interested in how the areas of medicine I mentioned affect other areas of the body, not just mental illness. For example; I've always been interested in how stress can impact the enteric nervous system, and I quite enjoy endocrinology, gastroenterology, cardiology and sleep medicine. However, other than psychosomatic medicine, I'm not absolutely in love with other areas of medicine the way I am with the mind/brain/psychology/psychiatry.

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The fact that you like medicine in general is a good sign. Having a particular love is a nice thing too. When you get through medical school, you might very well find that you fall in love with something even more than psychiatry. It's tough to say from the get go, but my guess is that about 75% of people in my class ended up in a different specialty than the one they entered medical school with.

The Everglow said:

I'm more concerned about the 2 intern years and the first year of residency (I'm not sure how it is in the States, but up here in Canada psychiatry is a 5 year residency with the first year being a basic training year of ER medicine, internal, cardiology, family med, psychiatry etc.).

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Can't talk for Canada, but the intern year here isn't too bad. It varies by program, but it's one year and six months is medicine/neurology and the other six is psych. The medicine/neurology stuff is all Doctor 101 stuff, but it's good training that all physicians need and even the bad rotations are just good reminders for why you chose psych. I'm brand new to it, but from looking at my schedule and looking at the schedule of my fellow interns, the workload averages out to more than someone at Radio Shack but less than your average professional in tech or law.

nitemagi said:

If I were in your shoes, I would think longitudinally - Psychologists work hard for less money, have more competition after training, and can't get much medical training easily without a lot of fellowships. It's a lot easier (and wanted by others) to get extra therapy training as an MD.

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Good advice, this ^^^.

I'm a 4th year med student, and I didn't know that I wanted to do psych when I started med school. I have lately wondered if I would have made the decision to go to med school (with all the work that comes with it) if I had known I was interested in psych from the start.

My answer, after some thought, is...Yes, I would go to med school again. Mostly for the reasons given above (medical training, longitudinal experience, etc).

That being said, it's a personal decision. There is a heavy debt load associated with medical school, but a higher income (theoretically) afterward. It's also a crap load of work. But, it may be a more flexible choice as well, if you do all the work to get a clinical psychology degree, and change your mind, your SOL. At least in medical school, if you change your mind (as I did), there are other options (although if you change it too late it can be difficult, but not impossible).

Good luck!

Fourth year medical student here, I did my undergrad work in Psychology and went through a similar debate myself back then. These days I still think it is a tough decision.

In favor of psychologists:
They get to do a lot of therapy and learn a lot about psychological theory. I think that's what many of us who are considering psych in college want out of a career in the mental health field. The opportunities for real connection and teaching for meaningful change are incredible here, and there is no economic pressure to ditch therapy in favor of med management because you can't do med management!

In favor of psychiatrists:
Our understanding of mental illness is evolving, and a lot of it is evolving toward the biological model. As we continue to discover more about mental illness those who don't understand the physical body and how it relates to the mind risk being left behind. Aside from that you get to take on seriously ill schizophrenics, bipolar patients, those with comorbid medical conditions, and for all of these people you can handle the full spectrum of medication and therapy if you so choose. And while med management may cut into your therapy time, it will make you more money and it will be in very high demand almost anywhere.

Initially I would say that I regretted my decision, but I am coming back around to believe that I'm in the right place. I am interested in academic psychiatry and with my MD I can do research in therapy, basic science, pharmacology, almost anything. I feel like the medical training gives me a unique perspective and lets me be more of the 'total provider' for mental health services that I am interested in being. I think both professions have some powerful draws, but I'm pretty happy I chose psychiatry.

The Everglow said:

Thanks for all of the insights guys, I really appreciate it. It's some good food for thought!

And if anyone else has some advice, I'd love to hear it

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Go to medical school.

If you don't have an absolute passion for research, I would not go the Clinical Psych PhD route.

wow.......i went through the EXACT SAME DEBATE 7 months ago.....
i love both psychiatry and psychology, there are pros and cons to each...i was seriously considering getting a psy-d and pursuing clinical psychology...i somehow got accepted into medical school and was then even more conflicted. In my mind i have psychiatry as my end goal, but i do find medicine interesting and am open to other fields that might interest me even more...maybe neurology but who knows.....

this is what i concluded...
-a psychiatrist can do ALMOST EVERYTHING a psychologist does if he/she really wants to do it...legally speaking you dont need a psy-d or phd in psychology to give therapy...you can get extra training in therapy techniques on your own or through your residency program.

-a psychologist CANNOT do things that a psychiatrist can legally do when it comes to medication...and lets be real, certain patients NEED medication as therapy isnt always enough.

so....a psychiatrist can see more patients...CAN HELP PATIENTS IN MORE WAYS...knows more about the human brain and body...makes more than 2x the salary...can work basically anywhere you want....and the big thing is this....it takes almost the same amount of time to train in both...a PHD is no joke, it takes 4-6 years (by then you will be a pg-2). I mean a phd is the real definition of a doctor when you really think about it...one path isnt easier then the other...

Did i make the right choice by accepting my seat in medical school? I dont know yet....but i think i did honestly. I seriously do enjoy psychiatry and psychology in my heart and they are BOTH GREAT FIELDS. But i want to see more patients and have more control of my life (be my own boss have my own clinic).

i'm really looking forward to learning about the human body and being a master of medicine...fingers crossed* I think i'm in a win-win situation...but thats my personal view

and as someone who has other ambitions in life (staring small businesses, doing charity work, ect)...there is a huge difference a 70k salary and a 200k salary......money isn't everything, but it brings options...and i want to do great things for my community with the extra money i make

Medical school will put a student into a very rote-memorizing type of atmosphere where there is little training on mental health. If the person's true passion is mental health, be prepared for years of having to memorize hundreds of pages of data, much of which has hardly anything to do with your passion, and then spit it out on multiple choice tests to the point where you feel like you're a meat ticker tape machine, while being with colleagues who care little, if anything at all, for your passion for mental health, and will likely discourage you from it.

Also expect to be with professors of various medical fields such as anatomy, physiology etc, all tell you that psychiatry is BS (because they are egocentric and don't understand it, while you happen to pay uber amounts of tuition to pay these shmucks). While some may simply view this as a temporary obstacle, its one that will last for years. By the time you get out of it, you won't be the same. IMHO, you can't look at it that way. It's like going into a marriage you know will not work, but only looking at the marriage as a temporary thing. It's temporary, but then again all of life is that. It's too long and difficult to merely see this as temporary because you will have to change your way of life (for the rest of your life) over it.

The pay off is you'll have better job security, likely make much more money, and you'll have many of the same capabilities as a psychologist, though you will lack training in several of the things they have such as being able to do an MMPI, training in several psychometric tests, and better footing to do a publication (MDs IMHO are more about multiple choice tests, where as graduate curriculums outside of medicine are more about publications and preparing a thesis).

Psychology encompasses the entire breadth of the human mind, while psychiatry only focuses on mental illness, and it's further specialized (or boxed-in) into a medical standpoint on it. You'll get better training in statistics, testing, studying several phenomenon that medical doctors don't get trained in that will likely help you understand the mentally ill. E.g. better training in learned helplessness, lack-of-control experiments that cause anxiety, sensation and perception and how they affect mental states, etc.

An advantage is you'll always be in a pro-psychology/mental health environment. You will be challenged to push the field forward, and get active participation in projects that do such, where as medstudents are mostly about taking in obscene and inhuman amounts of data and being able to spit it out not in an gestalt/organic way but in a multiple choice test type of way (like I said, ticker-tape). You will have opportunities to work in areas of the human mind outside of mental health.

A drawback is poorer job security, a pay that will likely be less, and a state of anxiety over the state of your publication/thesis that you know will be highly subjective (based on who grades it). You will also likely have less knowledge and clinical experience on mental states caused by medical phenomenon such as UTI induced delirium.

The groupthink that happens when the old and tired argument of psychiatry vs. psychology only proves that even mental health professionals cannot objectively judge something when it's their own butts on the line.

Ask a psychiatrist what "groupthink" means on-the-spot, and I'd bet you less than 10% would know. It's not in the medical or psychiatric curriculums because it's not a medical phenomenon, yet it is a very important concept in understanding how people think. Of the psychiatrists who would know this, it's only because someone pointed it out to them, they didn't know it and they looked it up. It's not because they learned it in training.

Geez, learning (edit: how) people think would be important to psychiatry? I guess not because a lot of stuff isn't taught in the field that is taught in psychology. Putting a guy in a brightly lit flourescent orange room for days straight is going to affect his mood. Psychiatrists have no training in that type of thing.

(I'm only bashing psychiatry a bit more because this is a psychiatry forum. Psychologists pushing for medication prescription with barely any real medical training are also ticking me off).

If people would just freakin be honest and say they're protecting their own turf because it's about the $$$.

whopper said:

Ask a psychiatrist what "groupthink" means on-the-spot, and I'd bet you less than 10% would know. It's not in the medical or psychiatric curriculums because it's not a medical phenomenon, yet it is a very important concept in understanding how people think. Of the psychiatrists who would know this, it's only because someone pointed it out to them, they didn't know it and they looked it up. It's not because they learned it in training.

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Or because we've heard of the Kennedy Administration. Come on, whopper. Give us a LITTLE bit of credit.

I'll give you credit.....but not a lot of others.

whopper said:

(I'm only bashing psychiatry a bit more because this is a psychiatry forum. Psychologists pushing for medication prescription with barely any real medical training are also ticking me off).

If people would just freakin be honest and say they're protecting their own turf because it's about the $$$.

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I love your post. A lot of people in the Clinical Psych forum talk about how clinical psych hopefuls should pursue psychiatry instead, and it upsets me because I don't want to do what a psychiatrist does. Not that I don't respect what you guys do, I just think we have very different training and therefore also very different strengths and weaknesses.

My advice to the OP is simply because they said they don't have a huge interest in research. Clinical psych PhD programs focus a lot on research and you receive a lot of training in it. Even someone who loves research can get burnt out in grad school, so if you're already neutral towards it that could lead to you being very miserable. Similarly, assessment training also requires a good grasp of research.

hmm.....i feel uncomfortable about starting school sometimes lol.....maybe i didn't make the right choice afterall

carolinablue said:

hmm.....i feel uncomfortable about starting school sometimes lol.....maybe i didn't make the right choice afterall

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You'll be fine...pretty much everyone feels that way. You'll feel it again when starting 3rd year, and again with each new rotation (surgery or OBGYN = Gulp!), and again when starting residency, and I'm sure many times after that.

I just wanted to add that it is possible that you'd be very happy doing either, so try not to sweat the decision too much. I was in a somewhat similar place (clinical psychology vs medicine for a couple years then clinical health psychology vs medicine later on). Really, it was about 25/75 psychology/medicine until I discovered health psychology, when it became essentially a 50/50 toss up. The reasons why are a little tough to elaborate on with brevity, so just take it for granted that I had good reasons for each. By the time I had fallen in discovered and fallen in love with health psychology though, it was fall of senior year - I was already holding a med school acceptance half way through that semester. Medicine has better job security/$, and I was already very far along in the admissions process. So I chose medicine (and added on an MPH in behavioral and community health sciences). I definitely have worried about choosing the "wrong" thing, until I realized it was really just a choice between two things that seemed to fit me great. Eased up the worry.

May or may not apply to you, but something to think about. I can't retrospect on my decision, since I'm an incoming first year!

cara susanna said:

I love your post. A lot of people in the Clinical Psych forum talk about how clinical psych hopefuls should pursue psychiatry instead, and it upsets me because I don't want to do what a psychiatrist does. Not that I don't respect what you guys do, I just think we have very different training and therefore also very different strengths and weaknesses.

My advice to the OP is simply because they said they don't have a huge interest in research. Clinical psych PhD programs focus a lot on research and you receive a lot of training in it. Even someone who loves research can get burnt out in grad school, so if you're already neutral towards it that could lead to you being very miserable. Similarly, assessment training also requires a good grasp of research.

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Actually, according to the mere exposure effect if he is feeling neutral towards research in graduate school he would grow to love it.....or end up falling victim to effort justification.......Anyway, I am on the fence as well; however, being that I am graduating in May 2012 with a psychology major I would have to spend another 1-2 yrs meeting prerequisites for med school. I'm already 25, so I think my decision is made

walt55054life said:

Actually, according to the mere exposure effect if he is feeling neutral towards research in graduate school he would grow to love it.....or end up falling victim to effort justification.......Anyway, I am on the fence as well; however, being that I am graduating in May 2012 with a psychology major I would have to spend another 1-2 yrs meeting prerequisites for med school. I'm already 25, so I think my decision is made

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Since when does exposure turn neutral to positive, rather than negative to neutral?

I would think about the longitudinal course, rather than an extra year or two. We're talking about the rest of your life, after all.

nitemagi said:

Since when does exposure turn neutral to positive, rather than negative to neutral?

I would think about the longitudinal course, rather than an extra year or two. We're talking about the rest of your life, after all.

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Can't recall the exact study but if first negative it will become more negative having a social allergy (if you hate the Beatles when you first hear them, more exposure will create more hatred); however if neutral or positive the propinquity and mere exposure state we will grow a liking. Also, it was all a joke

nitemagi said:

Since when does exposure turn neutral to positive, rather than negative to neutral?

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I can't recall the details but neutral becomes positive. So if you feel neutral towards your neighbor, you come to like her after many interactions. If you already liked her, you come to love her. If you disliked her, you come to hate her. The last one, I call the Lady Gaga Effect.

cara susanna said:

My advice to the OP is simply because they said they don't have a huge interest in research. Clinical psych PhD programs focus a lot on research and you receive a lot of training in it. Even someone who loves research can get burnt out in grad school, so if you're already neutral towards it that could lead to you being very miserable. Similarly, assessment training also requires a good grasp of research.

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This is right. It's one thing to enjoy doing research on the side, and another to ENJOY doing research. OP, the best way to find out, in my opinion, is to take part in every aspect of a study in undergrads. And really participate. For instance, I'm a big picture person. I don't mean to toot my own horn, but I'm great designing research studies. Though theoretically that's the most important part of the study, practically it's the least important. The important stuff is being organized, disciplined, motivated, persistent, and resourceful. It's about having initiative. My adviser was mostly absent and I had hell of a time completing my project. I came to really hate research by the time I completed my masters.

Personally for me (and this is not for everyone), I enjoy psychiatry and I am happier as a psychiatrist vs. what I think I'd believe I'd be as a psychologist.

But it was a heck of a long and tough journey. Several times I felt out of my element, and IMHO medical training, culturally, has not been about treating patients to the degree it should be. I remember several times seeing doctors scream at people under them, treat their patients as if the patient should be kowtowing to them, and then even say it was one of the benefits of being a doctor.

By the time I hit residency, I was happy, but medical school, like I said, it long, and it changes you. It's like I guess being married, living in another country, or going to war, all of them for years. You really can't just look at it as a temporary obstacle that you'll overcome because it's too long and requires too much effort. If you love psychology, and aren't very interested in the other specialties as much, I can see a person being very frustrated.

I think another added frustration was I believed many of the tests were not accurate in what they were testing us on, and my training in psychology (though not at the graduate level) only emphasized the lack of reliability and validity with many of the multiple choice tests I took. E.g. a class average of less than 40% on a test reeks of being a bad test. I remember several colleagues being weeded out based on such tests and being told they were no good when I believed the instructor didn't make a good test and used it as a BS excuse.

Carlat in another thread mentions this is why he feels psychiatry should have a different curriculum of sorts. I do think there could be a place for a clinician with more psychology training and less medical training, but ultimately, I also believe that there needs to be psychiatrists that have as much training as the other M.D.s. I've had too many situations where the mental health and psychotropic meds were of great medical concern. I believe medical training in general (for all doctors) doesn't need to be so complicated; for example don't make medstudents memorize every single step of the Krebs cycle, every single enzymatic pathway to the degree where every step is required, make medstudents take more classes in undergrad that are clinically relevant such as psychology or sociology. Psychotherapy should be utilized more.

whopper said:

But it was a heck of a long and tough journey. Several times I felt out of my element, and IMHO medical training, culturally, has not been about treating patients to the degree it should be. I remember several times seeing doctors scream at people under them, treat their patients as if the patient should be kowtowing to them, and then even say it was one of the benefits of being a doctor.

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Some of this is school/location dependent. While I agree that much of medicine, especially hospital medicine, isn't about the patients as much as it should be, most of the physicians I've encountered have been good people without too much of this attitude. Then again, I go to DO school, and have done a lot of community medicine rotations, either in decent sized community hospitals, state psych facilities, or private physician offices...so my experience has been a little different. Then again, this is the environment I want to practice in, not academia, so I'm happy with it. I've also been in the southeast, where the people have a little more of that southern hospitality. I actually disliked seeing some patients in Florida, because many of them were northern transplants and tended to be downright MEAN and rude.

medical school, like I said, is long, and it changes you. It's like I guess being married, living in another country, or going to war, all of them for years. You really can't just look at it as a temporary obstacle that you'll overcome because it's too long and requires too much effort. If you love psychology, and aren't very interested in the other specialties as much, I can see a person being very frustrated.

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Agreed. Although I'd disagree about the obstacle part. I think you can still look at is as an obstacle to overcome, as long as you view it as either many smaller obstacles, or one GIANT one. I have always viewed my medical training in stages and just concentrated on getting through each one, while learning as much as I could on SDN about the next one:

Stage 1: Finish Undergrad (4 years)
Stage 2: Basic Science Years (2 years)
Stage 3: Clinical Years (2 years)
Stage 4: Intern Year (1 year)
Stage 5: Residency (2 years after intern for fast track C&A)
Stage 6: Fellowship (2 years for C&A)
Stage 7: Attending and Beyond

Also I'd add that although it's frustrating to learn about all the aspects of medicine you likely won't use, you can often find a way to apply that knowledge to psych. I'm currently on a pediatrics rotation and just saw a kid with ADHD, another who has a lot of anxiety about his family finding out about his sexual orientation, another who has issues with her Bio-Dad, a Mom whose husband was caught fondling a niece and is now depressed...and on and on. In one day of rural pediatrics. There's plenty of psych pathology out there, if you take half a second to look for it.

I think another added frustration was I believed many of the tests were not accurate in what they were testing us on, and my training in psychology (though not at the graduate level) only emphasized the lack of reliability and validity with many of the multiple choice tests I took. E.g. a class average of less than 40% on a test reeks of being a bad test. I remember several colleagues being weeded out based on such tests and being told they were no good when I believed the instructor didn't make a good test and used it as a BS excuse.

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Someone needs to teach teachers how to teach. The worst teachers I've had in my entire life were in undergrad. There were a couple of shining beacons there, both at my Community College, and at my University, but most of the professors just wanted to get back to their research and NO business writing a test or "teaching" students.

Med school was mercifully better, but I think my school excels in test writing, and we did have VERY well written multiple choice tests, and the tests were analyzed for bad questions which were thrown out of the test if they were missed by a certain percent of the class. Usually we'd have a few on a 200 question test, but not many. Once they were gone, they were gone from the bank for good, or rewritten, so over the years, they've weeded out many of the bad ones and wound up with a pretty strong question bank to pull Q's from.

I believe medical training in general (for all doctors) doesn't need to be so complicated; for example don't make medstudents memorize every single step of the Krebs cycle, every single enzymatic pathway to the degree where every step is required, make medstudents take more classes in undergrad that are clinically relevant such as psychology or sociology. Psychotherapy should be utilized more.

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I think the amount of training we receive in psych is laughable, especially considering the prevalence of mental illness. At my school, we had a couple of weeks "mini-course" on it, which no one really paid attention to. We had to pass a pretty easy test. Then we have to do a one month psych rotation in our 3rd year. I did a second month 3rd year, and am doing a couple more this year. We do get some exposure during other medicine rotations, especially family med, but really only if you look for it and are interested in it. We're mostly there to do H&Ps and learn to make plans, so talk therapy gets totally glossed over on medicine (and on psych too really).

I think we should restructure medical education to accurately reflect the prevalence and severity of disease. Everyone should get near-specialist level training in Cardiovascular Disease, Diabetes, Hypertension, Depression, Anxiety, Common Cancers, Thyroid, Renal Failure, etc...and much, much, much less training on zebras like Prader-Willi or Krukenberg's tumor (which honestly should not be mentioned to anyone who's not a pediatrics or FM resident(for Prader Willi) or an OBGYN, or GI resident (for krukenberg).

Why do I, a 4th year medical student, have any idea what those things are? How is that going to help anyone? That time could be MUCH better spent by improving my training in things that I am going to see, like psychiatric issues.

While we're at it, we should get SOME training on health systems. How to run an office or practice, or whatever specialty we're interested in. I honestly believe that there should be 1 month clinical rotation devoted to business training relating to your chosen field, taught by a clinician with a proven track record of running a successful practice. Also, some training in things like Medicare vs Medicaid, and other "Delivery/Systems" issues would be nice. I know quite a bit about health policy (mostly thanks to SDN), but I can't tell you how many classmates I have who have no idea what a CPT code is, or what the difference is between Medicare and Medicaid (Medicare part D, what?), or even how doctors get paid. This is basic stuff, that we're not being taught. It's like an accountant who can't use a calculator.

I very much agree with your post. I didn't go to a DO school so I don't know how much the attitude differs but I do recall asking my DO colleagues if they felt there was some type of overcompetitive atmosphere in DO school and all told me no, while most MDs I know didn't feel that way.

whopper said:

I very much agree with your post. I didn't go to a DO school so I don't know how much the attitude differs but I do recall asking my DO colleagues if they felt there was some type of overcompetitive atmosphere in DO school and all told me no, while most MDs I know didn't feel that way.

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There's definitely "gunners" and there's definitely people who will refuse to do anything that might help you (say, share a helpful link or PDF file), but for the most part, I'd say it's been very collegial. Then again, not everyone is trying to do Derm...

Then again, I think some of the less competitive MD schools are that way as well. I've had some friends go to EVMS who loved it and I've only heard good things about the atmosphere there, but not exactly top tier, and also at a non-school owned (although next-door) community (but tertiary) hospital...

Some of it, I think, has to do with the competitive nature of med students in general. Many people have trouble "letting go" of that drive that got them into Harvard (or wherever) in the first place, and continue to try to achieve the most competitive thing they can, even if it's not what they really want. I think this is more likely to be found in the higher tier, more competitive schools...

digitlnoize said:

There's definitely "gunners" and there's definitely people who will refuse to do anything that might help you (say, share a helpful link or PDF file), but for the most part, I'd say it's been very collegial. Then again, not everyone is trying to do Derm...

Then again, I think some of the less competitive MD schools are that way as well.

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I think this is just as true at the higher-tiered schools as well. In a class of 150+, I can only think of about two people that I wouldn't have considered to be collegial.

Getting back to the topic at hand, I've got to say I'm not sure. Admittedly I'm a 2nd year currently in the crappy part of the psych world (ie the call pool), but it's a long road with a lot of extraneous stuff that can be pretty painful when you want to do therapy and treat outpatients. Of course I've never done a clinical psychology program and really don't have any people close to me who've done, so I can't compare notes. It's possible that it's super hard and stressful, too.

Anyway, my run down of the suckitude of doing medicine --

premed stuff -- stressful because schools are kinda arbitrary
basic sciences -- imo, not too bad. You could set your schedule and study. We also had a decent amount of human behavior, so win
3rd year -- mostly lame
4th year -- interviewing is stressful but otherwise pretty cool
internship -- better than third year, medicine months can suck, inpatient psych months can suck, call sucks. We do work less than other residents, but it's still a lot of work. I worked about 70 or so hours a week on psych rotations and 70 to 80+ on medicine. Neuro and outpt medicine, though, were more like 35 to 40/week.
2nd year -- only a month in, but call still sucks. Starting outpt clinic, which I'm excited about, but that's only 1/2 day a week. The rest of the time is inpatient or c/l, and then of course call.
3rd and 4th year -- should be freaking great. All outpt or electives and practically no call!
Being an attending -- hopefully not horrible, but I have to remember to avoid taking an inpatient job because that would again suck.

So, hmm -- 1 year of crappy premed + 3rd year + 1/2 of 4th year + 1st and 2nd year of residency = 5.5 years of suckitude. If you hated basic sciences, make that 7.5 years (or 6.5 if you're one of those weirdos who loved 3rd year -- did you really?).

Of course my whole bitter ranting post is reflecting a need for me to get out of the goddamn call pool. Not a fan of sleep deprivation, mean people (see my rant in the residency forum about nurses who throw you under the bus) or antisocial jerks in the ED. I'm hoping I'll have more positive reviews about medicine (and psychiatry) next year.

Doctor Bagel said:

...Being an attending -- hopefully not horrible, but I have to remember to avoid taking an inpatient job because that would again suck. ....

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I empathize with your call-worn perspective, but just wanted to let you and your readers know that the suckitude of being an inpatient attending is many orders of magnitude less than that for a PGY2.

We now return you to Dr. Bagel's regularly scheduled, well-deserved, rant.

OldPsychDoc said:

I empathize with your call-worn perspective, but just wanted to let you and your readers know that the suckitude of being an inpatient attending is many orders of magnitude less than that for a PGY2.

We now return you to Dr. Bagel's regularly scheduled, well-deserved, rant.

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This is good to hear. To add some context to my rant, I was just on the downside of 19 days with no days off and got reminded just how much I hate call. But I still think this is a pretty darn long haul if you're specifically interested in doing therapy and treating outpatients, which I'm guessing is what most people trying to decide between these two specialties would be interested in. Being able to prescribe medications, though, is pretty useful.

what did you end up choosing in the end? I'm in the same boat, and I have absolutely no idea which one to go with.

Psychology is a very viable option if you go to a good university program. Unfortunately, there are lots of for profit psychology schools who flood the market and drive down salaries. Universities require research, Psy-D, not so much. University grads can get good academic positions, but again this means research. Psychiatrists do well with or without research. They can learn and do as much therapy training as they want. Doing therapy may not pay as well, but they will do as well as a psychologist when it comes to pay for doing it and you can do a mixture at any ratio you want. The only downside to the medicine route is medical school. Psychiatry residency is tough, but don’t say that on the other MD boards, unless you like being laughed at. It really isn’t that bad.

Psychology, less debt (in theory) and bill just as much while seeing fewer people per day. Especially if you're doing neuropsych testing.

Keeping it real, it comes down to one thing: do you want to be the sideshow or the main event?

I was just talking with a PsyD friend about this and she mentioned a huge bottleneck in applicants getting internships, and a lesser one in getting a post-doc. Just googling some quick stats it looks like 20-30% of psychology applicants don't match for an intern year annually. That's much smaller for psychiatry and something to keep in mind.

If I'm not mistaken, there's a big shortage of psychiatrists. There's a veritable supply of psychologists.

Psychologists have cornered the market on Self Help books. You hardly see books written by psychiatrists in book stores. Not very relevant, but I thought I'd throw it in. (I think psychiatrists can write just as well if not better if they tried and dedicated serious study to the psychological aspects of their work.)

the same goes for clinical psychology. There is a glut of clinical psychologists, most of whom with fairly dubious training. There is however a shortage of psychologists providing evidenced based treatments to underinsured populations. there is no parity in mental health, people with crappy insurance have to get prior authorization to have psychotherapy!

splik said:

the same goes for clinical psychology. There is a glut of clinical psychologists, most of whom with fairly dubious training. There is however a shortage of psychologists providing evidenced based treatments to underinsured populations. there is no parity in mental health, people with crappy insurance have to get prior authorization to have psychotherapy!

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I don't know that I'd say it's "most" of us, at least not yet. However, if the current trends keep up, in another 5-10 years, you might be right. It's also going to vary substantially by location--CA, based on its geographic desirability and surplus of less-than-reputable psychology programs, is likely going to have more poorly-trained psychologists than many other areas.

But I completely agree with everything else mentioned, re: both psychologists and psychiatrists. I'm fortunate in that I actually enjoy working in geographically less-desirable areas with traditionally-underserved patients, so finding a job wasn't terribly difficult for me. However, if I were dead-set on opening a cash-only private practice in LA or NYC, I wouldn't be able to walk a block without running into another one of "me" (some with equivalent training, some not).

.

AlbinoHawk DO said:

Keeping it real, it comes down to one thing: do you want to be the sideshow or the main event?

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....based on all of your years of experience as a medical student?

Therapist4Chnge said:

....based on all of your years of experience as a medical student?

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I'm a non-trad that worked in mental health for a few years and spoke to many people in both fields before making my choice of going to medical school.

AlbinoHawk DO said:

Keeping it real, it comes down to one thing: do you want to be the sideshow or the main event?

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That summarizes the whole thread...