Questioning the role of psychiatry in medicine

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PrideNeverDie

We're all gonna make it brah
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inspired by this thread: http://forums.studentdoctor.net/showthread.php?t=984859

some med students believe that psychiatry doesn't belong in medicine and that psychologists with prescription pads are a viable alternative

i'd like to hear from psych residents and attendings about times you had to use your medical school training in your field

in before "everything"

Neuropsych eval for atypical dementia.

Atypical early onset psychosis at age 14. Genetic syndrome.

Drug and alcohol withdrawal.

ECT and DBT requiring support from neurosurgeons or anaesthesia, for rx refractory depression psychosis suicidality or mania.

Polysubstance abuse.

Sexual trauma evaluation.

Palliative care of medically complex pts with significant psych issues.

And bread and butter delirium in the ICU
 
Those cases scenarios mentioned above are worth noting.

But I believe in the case of your typical outpatient med check world, having an MD does not necessarily make for a better practitioner. In that scenario, someone up-to-date on the use of psychiatric drugs is the best candidate, regardless of whether he or she has an MD.

As someone who values his relationship with a PsyD, I hope that psychologists don't get prescribing rights because the availability of good psychotherapy could decrease.

But at the same time, even other psychiatrists on these boards acknowledge there are some bad psychiatrists out there, who don't know what they're doing, which can be fairly tragic, especially when the material they need to know to make good prescribing decisions isn't that complex and certainly doesn't take an MD to acquire that knowledge base (nor is that knowledge base gained in the process of getting an MD).

I've been asked not to share the benefit of my personal experiences on this board, but suffice it to say there are likely practicing psychiatrists who got their MD degrees in the 50s and 60s, who are not benefitting their patients more with misinformation than a non-MD who is up-to-date, knowledgable, and intelligent.

It's always struck me as odd that in psychiatry's current incarnation, the biological model (which means drugs for most people) is so emphasized, yet with relatively little to master about drugs, some don't get around to that mastery. I think that mastery of that should be the ideal person to "do" psychiatry for the vast majority of patients who interface with psychiatrists. Because the current system is so incredibly inefficient. If you could certify people to become psychiatric drug experts, you could do it at far lower cost than a medical degree costs. Cost would be a lower barrier to entry. You'd have a larger population serving clients. Competition would increase. The amount of time a practitioner could spend with a client would increase.

I'm thinking right now about psychiatry's role in medicine. And it doesn't strike me as drastically different from other fields. But then I started to wonder: Is psychiatry not different from other fields of medicine because it wants to be part of medicine?

That is to say, where would the field be if it weren't trying to be accepted as legitimate through proving it can follow the disease/biological model? I'm not suggesting it would be emphasizing psychoanalysis. Just that it could be really anything. The treatment of the mind/soul as a goal leaves a pretty wide open field.
 
The treatment of the mind/soul as a goal leaves a pretty wide open field.

I think this totally misses the mark. Psychiatrists don't really treat "the mind or soul". The field is really moving in the direction of using specific medications and combination of medications to treat abnormalities in specific neuro circuits that manifest as behavioral disorders, and referring for cognitive behavioral rehabilitation services to other providers.

The power brokers in the field are much more interested in providing an EVIDENCE BASIS to everything that's being done than continuing to be burden by complicated questions in philosophy and humanities. There are various incentives for why this is, which we can go into at a later point, but it's a mistake to equate psychiatry to some kind of yoga-wellness wannabe branch of medicine. Remember that while Freud was one part of the origin in the history of psychiatry, much of psychiatry is MUCH OLDER than Freud and involved running insane asylums and typhus shelters.
 
But I believe in the case of your typical outpatient med check world, having an MD does not necessarily make for a better practitioner. In that scenario, someone up-to-date on the use of psychiatric drugs is the best candidate, regardless of whether he or she has an MD.
What is this "typical outpatient med check world?" If you're talking your average cat that is just on antidepressants, they aren't typically seen by psychiatrists. They are prescribed by family practitioners or internists.

The reason psychiatrists need an MD even in the "outpatient med check world" is that not all patients are 25 year old non-child bearing males in good physical health. Some are elderly, and have a slew of other conditions and risk factors that could be contributing to their mental illness that need to be recognized and worked up. Some are pregnant, and need to have a good knowledge of which meds are teratogenic and the risks/benefits of discontinuing their meds for depression, bipolar, etc. Some are going to be less-than-physically-healthy and a knowledge of how their psych medications interact with their other medications and the symptoms of their physical ailments that may mispresent as psychiatric symptoms is important.

The 15 minute med visit may be a big slice of many private practitioner's practice, but it ignores the fact that there will a lot of non-cookie cutter cases that require more than just reviewing side effects and renewing medications. And for each of those 15 minute med checks, there was (hopefully) a decent intake that requires more skill to ensure that you're not just prolonging someone's earlier mistake.

Your comment that the right person for the job is the one most familiar with the medication mistakes physicians for pharmacists.
But at the same time, even other psychiatrists on these boards acknowledge there are some bad psychiatrists out there, who don't know what they're doing, which can be fairly tragic, especially when the material they need to know to make good prescribing decisions isn't that complex and certainly doesn't take an MD to acquire that knowledge base (nor is that knowledge base gained in the process of getting an MD).
See above, before you reduce what a psychiatrist does to what a pharmacist does. Also, while I agree that there are a lot of bad psychiatrists out there, this is a reflection of being in a non-competitive field. There are also a lot of crappy family practitioners, pediatricians, and internists too.
 
There are also a lot of crappy family practitioners, pediatricians, and internists too.

You mean like the ones that prescribe 100 mg of amitriptylline for sleep, 120 mg of duloxetine for chronic pain, and then refer to psychiatry because the patient's anxiety is getting worse despite the prn Xanax, and maybe they need an antidepressant? Or could they have bipolar?
 
Those cases scenarios mentioned above are worth noting.

But I believe in the case of your typical outpatient med check world, having an MD does not necessarily make for a better practitioner. In that scenario, someone up-to-date on the use of psychiatric drugs is the best candidate, regardless of whether he or she has an MD.

As someone who values his relationship with a PsyD, I hope that psychologists don't get prescribing rights because the availability of good psychotherapy could decrease.

But at the same time, even other psychiatrists on these boards acknowledge there are some bad psychiatrists out there, who don't know what they're doing, which can be fairly tragic, especially when the material they need to know to make good prescribing decisions isn't that complex and certainly doesn't take an MD to acquire that knowledge base (nor is that knowledge base gained in the process of getting an MD).

I've been asked not to share the benefit of my personal experiences on this board, but suffice it to say there are likely practicing psychiatrists who got their MD degrees in the 50s and 60s, who are not benefitting their patients more with misinformation than a non-MD who is up-to-date, knowledgable, and intelligent.

It's always struck me as odd that in psychiatry's current incarnation, the biological model (which means drugs for most people) is so emphasized, yet with relatively little to master about drugs, some don't get around to that mastery. I think that mastery of that should be the ideal person to "do" psychiatry for the vast majority of patients who interface with psychiatrists. Because the current system is so incredibly inefficient. If you could certify people to become psychiatric drug experts, you could do it at far lower cost than a medical degree costs. Cost would be a lower barrier to entry. You'd have a larger population serving clients. Competition would increase. The amount of time a practitioner could spend with a client would increase.

I'm thinking right now about psychiatry's role in medicine. And it doesn't strike me as drastically different from other fields. But then I started to wonder: Is psychiatry not different from other fields of medicine because it wants to be part of medicine?

That is to say, where would the field be if it weren't trying to be accepted as legitimate through proving it can follow the disease/biological model? I'm not suggesting it would be emphasizing psychoanalysis. Just that it could be really anything. The treatment of the mind/soul as a goal leaves a pretty wide open field.

I agree with much of this.....the fact of the matter is the amount of pharm to really master cold isn't that much. And yet bunches of psychiatrist out in the community, who spend much of their time writing psych drugs, really havent mastered it.
 
inspired by this thread: http://forums.studentdoctor.net/showthread.php?t=984859

some med students believe that psychiatry doesn't belong in medicine and that psychologists with prescription pads are a viable alternative

i'd like to hear from psych residents and attendings about times you had to use your medical school training in your field

in before "everything"

as I've stated before(and the thread, like tons of other threads before it, confirms) most med students think very little of our specialty. The thing you most use med school training for in this field is probably things like picking up on non-psych med side effects that impact symptoms....that said, you could easily learn such things in training outside med school.
 
i'd like to hear from psych residents and attendings about times you had to use your medical school training in your field

i don't mean this in an offensive way but your question is a little naive. orthopods don't use their general medical training at all, they aren't 'real doctors' but no one ever says you shouldn't go to medical school to become an orthopedist. surgery is a relative newcomer to medicine having been completely separate and a denounced practice by physicians for many years. In the UK orthopods or surgeons are not considered physicians, they are not called "Dr." and in fact would be offended if referred to as such. They readily accept that their field is intellectually bereft and they don't care because they get to play with saws and other toys, identify and fix problems in a technical paradigm, and get renumerated very well for it.

Despite your typical orthopod not being able to manage pneumonia, hypertension, diabetes, AKI, or being able to tell you the basics of acid-base physiology or pharmacology (despite have learnt all this and done pretty well on the boards), orthopedics is paradigmatic of the current medical model. They make an observation of the patient (look), the examine the patient's joints (feel and move), they use radiographic information to facilitate making a diagnosis (x-ray), and based on the diagnosis offer a techincal solution in the form of surgery, or conservative management. The medical training isn't evident in what they know about the vast corpus of all areas of medicine, but in using a particular approach to diseases of the bones and joints, and having a particular approach to intervention. It is their skills, and their professional identity that secures orthopedics as a medical specialty.

In the same way, psychiatry isn't a medical specialty because we prescribe drugs, or can diagnose and treat UTIs or hypertension. It's not a medical specialty because of our technical or procedural skills (since we don't really do any). It's a medical specialty because we have a specific approach to the patients and their problems, that is based in our medical training. We make a careful observation of the patient (appearance and behavior, perception), we then interview the patient (history, speech, mood, affect, thought form, thought content, perception, cognition, insight, judgement), based on which we construct a differential diagnosis, and use laboratory, radiographic and occasionally psychological tests to narrow down the differential (routine and special investigations), and based on what we hear, what we see, what we smell, what we feel, and we experience, we construct a narrative that summarizes and contextualizes the patients problems (psychiatric formulation). This is then used to provide technical solutions and interventions for the patient (risk assessment, capacity assessment, drug therapy, psychotherapy, social and rehabilitative therapies).

Psychiatrists don't have a vast medical knowledge because we're not internists, we don't have amazing procedural skills because we're not surgeons or interventionists, most of us aren't public health physicians so don't have a vast understanding of systems and organizations of care. We have superlative self-reflective, interpersonal and communication skills. Yeah there are many psychiatrists who are terrible communicators, but there are many surgeons who are hacks, and many internists who can't make basic diagnoses. The point is on the whole, we use our reflective, interpersonal and communication skills to make diagnoses, construct formulations, and treat patients. How I relate to patients and how they relate to me is very much in the context of a doctor-patient relationship, and interpersonal and communication skills are a key part of the practice of medicine, it's just much more important for us than for orthopods.

Medical students often have a limited idea of what medicine is about, and given that we still expect you to cram 2 years of mostly irrelevant information which implies that medicine is a 'scientific' enterprise (despite there being nothing scientific about medical school), students often struggle with psychiatry. It doesn't help that there are so many terrible practitioners and numerous approaches to the psychiatric patient. Students often can't understand the idea of feeling one's way into the patient's experience (phenomenology) because they are incapable of doing so. When you find something challenging or difficult, or upsetting as psychiatry can be, and you happen to be a horrendous overachiever, you are liable to dismiss the field as a whole*.

*As has been commented on the basic knowledge needed for psychiatry is easy to grasp and its probably the easiest shelf exam etc. But the clinical skills are amongst the most difficult. at my med school the psychiatry OSCE had the highest failure rate of any exam. Lots of people used to fail the old ABPN oral boards, and the majority of people fail the clinical skill exam of the royal college of psychiatrists. Psychiatry is difficult to practice well, as easy as it is to practice poorly.
 
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Splik, that was a truly excellent post, thank you. I am particularly glad to hear your appreciation for the complexities involved with being a 'good' psychiatrist. One can certainly get by without honing skills in personality diagnosis, psychodynamic formulation, etc. - learning this well is a real challenge, but a tremendously valuable skill.
 
inspired by this thread: http://forums.studentdoctor.net/showthread.php?t=984859

some med students believe that psychiatry doesn't belong in medicine and that psychologists with prescription pads are a viable alternative

i'd like to hear from psych residents and attendings about times you had to use your medical school training in your field

in before "everything"

Worth the read:

http://www.psychiatrictimes.com/schizophrenia/content/article/10168/2117281
 
i don't mean this in an offensive way but your question is a little naive. orthopods don't use their general medical training at all, they aren't 'real doctors' but no one ever says you shouldn't go to medical school to become an orthopedist. surgery is a relative newcomer to medicine having been completely separate and a denounced practice by physicians for many years. In the UK orthopods or surgeons are not considered physicians, they are not called "Dr." and in fact would be offended if referred to as such. They readily accept that their field is intellectually bereft and they don't care because they get to play with saws and other toys, identify and fix problems in a technical paradigm, and get renumerated very well for it.

Despite your typical orthopod not being able to manage pneumonia, hypertension, diabetes, AKI, or being able to tell you the basics of acid-base physiology or pharmacology (despite have learnt all this and done pretty well on the boards), orthopedics is paradigmatic of the current medical model. They make an observation of the patient (look), the examine the patient's joints (feel and move), they use radiographic information to facilitate making a diagnosis (x-ray), and based on the diagnosis offer a techincal solution in the form of surgery, or conservative management. The medical training isn't evident in what they know about the vast corpus of all areas of medicine, but in using a particular approach to diseases of the bones and joints, and having a particular approach to intervention. It is their skills, and their professional identity that secures orthopedics as a medical specialty.

In the same way, psychiatry isn't a medical specialty because we prescribe drugs, or can diagnose and treat UTIs or hypertension. It's not a medical specialty because of our technical or procedural skills (since we don't really do any). It's a medical specialty because we have a specific approach to the patients and their problems, that is based in our medical training. We make a careful observation of the patient (appearance and behavior, perception), we then interview the patient (history, speech, mood, affect, thought form, thought content, perception, cognition, insight, judgement), based on which we construct a differential diagnosis, and use laboratory, radiographic and occasionally psychological tests to narrow down the differential (routine and special investigations), and based on what we hear, what we see, what we smell, what we feel, and we experience, we construct a narrative that summarizes and contextualizes the patients problems (psychiatric formulation). This is then used to provide technical solutions and interventions for the patient (risk assessment, capacity assessment, drug therapy, psychotherapy, social and rehabilitative therapies).

Psychiatrists don't have a vast medical knowledge because we're not internists, we don't have amazing procedural skills because we're not surgeons or interventionists, most of us aren't public health physicians so don't have a vast understanding of systems and organizations of care. We have superlative self-reflective, interpersonal and communication skills. Yeah there are many psychiatrists who are terrible communicators, but there are many surgeons who are hacks, and many internists who can't make basic diagnoses. The point is on the whole, we use our reflective, interpersonal and communication skills to make diagnoses, construct formulations, and treat patients. How I relate to patients and how they relate to me is very much in the context of a doctor-patient relationship, and interpersonal and communication skills are a key part of the practice of medicine, it's just much more important for us than for orthopods.

Medical students often have a limited idea of what medicine is about, and given that we still expect you to cram 2 years of mostly irrelevant information which implies that medicine is a 'scientific' enterprise (despite there being nothing scientific about medical school), students often struggle with psychiatry. It doesn't help that there are so many terrible practitioners and numerous approaches to the psychiatric patient. Students often can't understand the idea of feeling one's way into the patient's experience (phenomenology) because they are incapable of doing so. When you find something challenging or difficult, or upsetting as psychiatry can be, and you happen to be a horrendous overachiever, you are liable to dismiss the field as a whole*.

*As has been commented on the basic knowledge needed for psychiatry is easy to grasp and its probably the easiest shelf exam etc. But the clinical skills are amongst the most difficult. at my med school the psychiatry OSCE had the highest failure rate of any exam. Lots of people used to fail the old ABPN oral boards, and the majority of people fail the clinical skill exam of the royal college of psychiatrists. Psychiatry is difficult to practice well, as easy as it is to practice poorly.

Thank you for this. That was a revelatory bit of prose for me. And the OP for broaching the subject, I don't think naive is the right term. Uniformed and subject to the misinformation of the medical curriculum and the horrible practice of some psychiatrists is a more apt description, I know because I fit the description. And therefore have been wrestling with things I am seeing, hearing to understand what I am going to be applying for next year.

I wonder if the truly rigorous and engaging psychiatry department clerkship for medical students is a bit of a rare bird. If I didn't have strong instincts for what I want out of the patient doctor relationship and the help of some key individuals here to counter a lot of what I'm seeing and hearing I might've been headed a different direction. Because I like general medicine, infectious disease, women's health, pediatrics, and EM. It's just that what Splik talks about....and the way he talks about it...sounds like a natural fit and what I would most like to work at in my career.

Appreciate this conversation.
 
Thank you for this. That was a revelatory bit of prose for me. And the OP for broaching the subject, I don't think naive is the right term. Uniformed and subject to the misinformation of the medical curriculum and the horrible practice of some psychiatrists is a more apt description, I know because I fit the description. And therefore have been wrestling with things I am seeing, hearing to understand what I am going to be applying for next year.

I wonder if the truly rigorous and engaging psychiatry department clerkship for medical students is a bit of a rare bird. If I didn't have strong instincts for what I want out of the patient doctor relationship and the help of some key individuals here to counter a lot of what I'm seeing and hearing I might've been headed a different direction. Because I like general medicine, infectious disease, women's health, pediatrics, and EM. It's just that what Splik talks about....and the way he talks about it...sounds like a natural fit and what I would most like to work at in my career.

Appreciate this conversation.

Part of the problem is a disconnect between what something has the potential to be in the most ideal of all situations vs what it actually is.

As I've said before, a field isn't judged by what chairs or vice chairs at research powerhouses do on a daily basis....nor is it judged by the more famous infamous providers.

The problem most med students(and a lot of the medical community) have in terms of why they have a fairly poor view of psychiatry is that they do not feel the day to day practice of a psychiatrist(inpt, outpt, consults) is particularly stimulating or challenging. And yes some *do* recognize that the potential for it to be challenging in an ideal situation is there, but they also recognize that the reality is most psychiatrists aren't going to have a skill set consistent with that. Just like most internists aren't william olsler. The difference is that in medicine subspecialties most medical students do see how the 'typical' practitoner is more frequently challenged and does have a more impressive knowledge base that must be mastered in order to practice at what is considered a competent level. As others have said before, the reality is that it is just not too difficult to gain enough knowledge and enough of a skill set to practice what is considered competently(and be hired for it) in psychiatry.....and I'm not talking about the 'bottom 10%' of providers.

Now this doesn't mean you have to throw in the towel.....you can still do things to help your patients if you are motivated. But in terms of answering the question of why so many med students hold the views they do on psychiatry, that's a big part of it. They show up hemonc services and work with the typical(ie not mindblowingly good or accomplished) hemonc person and think 'wow this is impressive'. Working on psychiatry they do not get anything close to that same feeling.
 
Part of the problem is a disconnect between what something has the potential to be in the most ideal of all situations vs what it actually is.

As I've said before, a field isn't judged by what chairs or vice chairs at research powerhouses do on a daily basis....nor is it judged by the more famous infamous providers.

The problem most med students(and a lot of the medical community) have in terms of why they have a fairly poor view of psychiatry is that they do not feel the day to day practice of a psychiatrist(inpt, outpt, consults) is particularly stimulating or challenging. And yes some *do* recognize that the potential for it to be challenging in an ideal situation is there, but they also recognize that the reality is most psychiatrists aren't going to have a skill set consistent with that. Just like most internists aren't william olsler. The difference is that in medicine subspecialties most medical students do see how the 'typical' practitoner is more frequently challenged and does have a more impressive knowledge base that must be mastered in order to practice at what is considered a competent level. As others have said before, the reality is that it is just not too difficult to gain enough knowledge and enough of a skill set to practice what is considered competently(and be hired for it) in psychiatry.....and I'm not talking about the 'bottom 10%' of providers.

Now this doesn't mean you have to throw in the towel.....you can still do things to help your patients if you are motivated. But in terms of answering the question of why so many med students hold the views they do on psychiatry, that's a big part of it. They show up hemonc services and work with the typical(ie not mindblowingly good or accomplished) hemonc person and think 'wow this is impressive'. Working on psychiatry they do not get anything close to that same feeling.

Yep. So "judged" is like whatever to me. What shook me is that there might not be the opportunity for artful, high level practice.

What reinvigorated me is that the same impulse to protect the unwanted, feared, and stigmatized--notdeadyet's point--could be directed at elevating the practice itself. And could even motivate me for a educational career. Something I hadn't pondered much until confronting this problem in my career selection process.

Your sentiments are noted, they no longer bother me, and in fact motivate me. I choose a different adaptive defense mechanism than what you typically display here.

I can't decide if I regret being combative with you, so apologies would be insincere. But I really have nothing more to say to you, and not much else that I care to listen to. When I return in to consult for applications just keep it movin please.
 
Working on psychiatry they do not get anything close to that same feeling.

well not if you're around they won't!

I'm half-joking. You're right, when students are told they just need to learn some DSM-IV criteria, ask everyone "do you hear voices?", "are you suicidal", "do you have thoughts of hurting others?", see everyone dx with "psychosis NOS" or "schizoaffective d/o", told to learn psychopharm, and then see everyone on the same inexplicable drug combos they are going to come away with a negative view of psychiatry.

Now I'm nothing special, and of course my students could be sucking up to me or just easy crowd to please, but they more often than not come away saying "wow". They say wow when the malignant catatonic patient becomes unstuck with an IM lorazepam shot. when the borderline patient with melancholic psychotic depression who won't eat, speak or move, agrees to eat and starts to speak again because I tell her she's so ill and I don't know how to help her and thus validate her need to be told she is the most difficult or sickest patient we've had. They say "wow" when they see the woman with chronic PTSD feel safe and secure and rapidly helped with hypnotic treatment. They are impressed when I share a psychodynamic formulation of a patient who attempted suicide. They are impressed when our floridly psychotic first-breaker with absolutely no insight, realizes he might have schizophrenia in our group therapy session. They are excited when I discuss the workup of our patient with delusional parasitosis, executive dysfunction, impairments in short-term memory, cogwheeling and diffusely brisk reflexes and clonus, we discuss diff dx and they learn about Biswanger's, CADASIL, PACNS, anti-NMDAR limbic encephalitis and other disorders they've never heard of before.

I think the DSM has a lot to answer for. In the same way US physicians have poor physical examination skills because of the CT scanner, the DSM which is supposed to be a "guideline" and not the final word on diagnose has intellectually and clinically impoverished psychiatry and most residencies no longer teach descriptive psychopathology, phenomenology, or detailed approaches to case formulation beyond different psychodynamic approaches.

Edit: on second thoughts most residency programs NEVER taught those things.
 
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I think the DSM has a lot to answer for. In the same way US physicians have poor physical examination skills because of the CT scanner, the DSM which is supposed to be a "guideline" and not the final word on diagnose has intellectually and clinically impoverished psychiatry and most residencies no longer teach descriptive psychopathology, phenomenology, or detailed approaches to case formulation beyond different psychodynamic approaches.
.

I think it's critical that med students are taught about the DSM in this way. That's how I was taught about it, but I know a lot of people who just learned it as "the guidelines to memorize for the exam," which is why they developed a very negative view of psychiatry.
 
I think the DSM has a lot to answer for. In the same way US physicians have poor physical examination skills because of the CT scanner, the DSM which is supposed to be a "guideline" and not the final word on diagnose has intellectually and clinically impoverished psychiatry and most residencies no longer teach descriptive psychopathology, phenomenology, or detailed approaches to case formulation beyond different psychodynamic approaches.

Edit: on second thoughts most residency programs NEVER taught those things.

I must admit that I entered residency with grave concern that this would be the case, but I have been surprised thus far - we have received extensive input on detailed case formulation, and my attendings would be thoroughly unimpressed if the emphasis of my case presentations were DSM criteria.
 
Yep. So "judged" is like whatever to me. What shook me is that there might not be the opportunity for artful, high level practice.

What reinvigorated me is that the same impulse to protect the unwanted, feared, and stigmatized--notdeadyet's point--could be directed at elevating the practice itself. And could even motivate me for a educational career. Something I hadn't pondered much until confronting this problem in my career selection process.

Your sentiments are noted, they no longer bother me, and in fact motivate me. I choose a different adaptive defense mechanism than what you typically display here.

I can't decide if I regret being combative with you, so apologies would be insincere. But I really have nothing more to say to you, and not much else that I care to listen to. When I return in to consult for applications just keep it movin please.

lol....that's not the way this game is played. No need for apologies on your part(what for?), and you are certainly more than free to ignore any poster....but what you most certainly cannot expect is for a poster to 'keep it movin'.....

And I like parts of what you write above, but the truth is that we all have to work within the system to some degree. There are external forces at work that limits us in this field...some moreso than others(depending what it is we do). It's nice to talk about 'artful practice' and such things, but that has to be reconciled with the realities of those external forces that we have no control over in our field.
 
". They say wow when the malignant catatonic patient becomes unstuck with an IM lorazepam shot..

really? or do they think(and may have already known) "so just give benzos IM/IV to pts like this....I think I can remember/handle that"
 
really? or do they think(and may have already known) "so just give benzos IM/IV to pts like this....I think I can remember/handle that"

the beauty is in the simplicity. lorazepam challenge is psychiatry's tensilon test. there;s nothing rocket science about giving edrophonium either but it's pretty cool. i was pretty excited the first time i used IV haloperidol for acute behavioral disturbance. med students get excited the first time they do a blood draw. it's instant gratification.
 
If they think psych isn't medicine they're more than welcome to see all the ED consults and admit them to medicine.

Seriously, psych patients are more likely to have more serious medical illness than other patients, and many of our patients can't or won't see a PCP.

Had Medicine residents try to tell me that an older guy with hepatic encephalopathy had new onset schizophrenia because he was hallucinating and "it got better with Haldol." Yeah, we don't need psychiatrists. Sigh.
 
Neuropsych eval for atypical dementia.

Atypical early onset psychosis at age 14. Genetic syndrome.

Drug and alcohol withdrawal.

ECT and DBT requiring support from neurosurgeons or anaesthesia, for rx refractory depression psychosis suicidality or mania.

Polysubstance abuse.

Sexual trauma evaluation.

Palliative care of medically complex pts with significant psych issues.

And bread and butter delirium in the ICU



Neuropsych evaluation for atypical dementia is performed by clinical neuropsychologist. Sexual trauma evaluation is finely performed by clinical psychologist as well.



Flame as much as you want, but a rigorous 5-year doctorate in medical psychology (with physio, biochem, pharma training right from the beginning of the doctorate and not in some crappy post-doc 2-year masters) would be at least an equally efficient alternative to the psychiatric post-MD residency mode IMO (fe.g. economic/supply-demand in relations to quality of services given) l. The reason that it is not applied is due to protectionism/lobbying of the psychiatry occupation and not in relation to some empirical data or scientific rationale.
 
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really? or do they think(and may have already known) "so just give benzos IM/IV to pts like this....I think I can remember/handle that"

Seriously your world must suck. Have you no sense of wonder? The notion that a sedative anxiolytic would allow someone to suddenly awaken/engage is counterintuitive and is a wonderful way to start understanding the complexity of catatonia. I know there is no nudity involved, but seriously, develop some passion for your field. Passion is contagious and your students will be more engaged.
 
Seriously your world must suck. Have you no sense of wonder? The notion that a sedative anxiolytic would allow someone to suddenly awaken/engage is counterintuitive and is a wonderful way to start understanding the complexity of catatonia. I know there is no nudity involved, but seriously, develop some passion for your field. Passion is contagious and your students will be more engaged.

Actually, the patient I was thinking about had an underlying delirious mania that was revealed with cessation of haldol and scheduled benzos such that she did take her clothes off and try to have sex with all male staff and patients 😱
 
Seriously your world must suck. Have you no sense of wonder? The notion that a sedative anxiolytic would allow someone to suddenly awaken/engage is counterintuitive and is a wonderful way to start understanding the complexity of catatonia. I know there is no nudity involved, but seriously, develop some passion for your field. Passion is contagious and your students will be more engaged.

👍

Your attitude about psych affects how your students view the field. I had a great IM senior my first month, and an awful one my second month. My attitude about IM changed dramatically during the course of that rotation.
 
Actually, the patient I was thinking about had an underlying delirious mania that was revealed with cessation of haldol and scheduled benzos such that she did take her clothes off and try to have sex with all male staff and patients 😱

😱 is right. Maybe V will be excited about what he does after hearing that part of the story.

I just can't help but wonder whether his med students were disengaged and/or disappointed because he didn't show them the ways in which psychiatry terribly complex, exciting, engrossing, and rewarding. That is not always evident at face value, and perhaps he doesn't even recognize it for himself. I suppose the confirmation bias that we all suffer from as humans with brains would lead people like you and I who have an underlying belief that psychiatry is tremendously rewarding to selectively attend to information that confirms that. I suppose V might selectively ignore those aspects of psychiatry and focus on all the ways that it's just bad medicine/not medicine at all/not rewarding/not interesting.

I'm glad he's not taking those academic positions that he mentioned.
 
👍

Your attitude about psych affects how your students view the field. I had a great IM senior my first month, and an awful one my second month. My attitude about IM changed dramatically during the course of that rotation.

Academia and the teaching of residents/students is a very small part of Medicine/psychiatry. There is a world out there beyond residency.
There are some excellent cynical doctors out there.
 
Neuropsych evaluation for atypical dementia is performed by clinical neuropsychologist. Sexual trauma evaluation is finely performed by clinical psychologist as well.



Flame as much as you want, but a rigorous 5-year doctorate in medical psychology (with physio, biochem, pharma training right from the beginning of the doctorate and not in some crappy post-doc 2-year masters) would be at least an equally efficient alternative to the psychiatric post-MD residency mode IMO (fe.g. economic/supply-demand in relations to quality of services given) l. The reason that it is not applied is due to protectionism/lobbying of the psychiatry occupation and not in relation to some empirical data or scientific rationale.

agreed....I brought this up last week. In my opinion that would be a career path that would prepare the best clinicians to do it all- evaluate, prescribe, therapy, etc....and for a shorter total time after undergrad.
 
Seriously your world must suck. Have you no sense of wonder? The notion that a sedative anxiolytic would allow someone to suddenly awaken/engage is counterintuitive and is a wonderful way to start understanding the complexity of catatonia. I know there is no nudity involved, but seriously, develop some passion for your field. Passion is contagious and your students will be more engaged.

I've had students really enjoy the time spent on my service....just three months ago had a ms-3 on inpatient with me who said he had a great time and really enjoyed the experience. Said he will remember a few of the patients he met for a long time. But while he thought it was fascinating(at least a few of the patients), I don't think he felt it was fascinating within the context of medicine.....he also thought family guy is awesome as well, but he's not going to try to make his career being a writer on the show.
 
Neuropsych evaluation for atypical dementia is performed by clinical neuropsychologist. Sexual trauma evaluation is finely performed by clinical psychologist as well.



Flame as much as you want, but a rigorous 5-year doctorate in medical psychology (with physio, biochem, pharma training right from the beginning of the doctorate and not in some crappy post-doc 2-year masters) would be at least an equally efficient alternative to the psychiatric post-MD residency mode IMO (fe.g. economic/supply-demand in relations to quality of services given) l. The reason that it is not applied is due to protectionism/lobbying of the psychiatry occupation and not in relation to some empirical data or scientific rationale.

While I appreciate your comments, this would be somewhat akin to saying you could beef up a couple psychiatry residencies by doing a few months more research, taking a few stats classes and then awarding a PhD and have them be equivalent, competent providers of psychological testing (or in this case neuropsychological testing). Being six weeks from finishing medical school, one of the greatest things I've learned is how very little I actually know. Coming out of the first two years, though I didn't think I knew a lot, I certainly felt I had at least a reasonable grasp of what was going on that I could at least formulate appropriate plans. It was the actual exposure to clinical medicine that helped me realize how much more nuanced things were. Of course, the argument could be made by those outside of psychiatry and/or medicine (and perhaps a small minority within it) that most of this is irrelevant.

Psychology itself is its own discipline and must be respected, so a five year PhD would have a substantial training component in psychology, obviously. I would have serious doubts about any meaningful study of basic sciences followed by clinical experience sufficient to make one a competent provider of psychiatric care. Having completed much more education, not to mention clinical exposure/experience, than graduating mid levels, I don't really quite see how their model is all that efficient as I feel I've been exposed to enough to appreciate how many loose ends are still present in my education. I have a hard time seeing how something inserted into a 5 year PhD curriculum (that's already full) could even approach the standard mid-level status-quo with regard to the medical component.
 
While I appreciate your comments, this would be somewhat akin to saying you could beef up a couple psychiatry residencies by doing a few months more research, taking a few stats classes and then awarding a PhD and have them be equivalent, competent providers of psychological testing (or in this case neuropsychological testing). Being six weeks from finishing medical school, one of the greatest things I've learned is how very little I actually know. Coming out of the first two years, though I didn't think I knew a lot, I certainly felt I had at least a reasonable grasp of what was going on that I could at least formulate appropriate plans. It was the actual exposure to clinical medicine that helped me realize how much more nuanced things were. Of course, the argument could be made by those outside of psychiatry and/or medicine (and perhaps a small minority within it) that most of this is irrelevant.

Psychology itself is its own discipline and must be respected, so a five year PhD would have a substantial training component in psychology, obviously. I would have serious doubts about any meaningful study of basic sciences followed by clinical experience sufficient to make one a competent provider of psychiatric care. Having completed much more education, not to mention clinical exposure/experience, than graduating mid levels, I don't really quite see how their model is all that efficient as I feel I've been exposed to enough to appreciate how many loose ends are still present in my education. I have a hard time seeing how something inserted into a 5 year PhD curriculum (that's already full) could even approach the standard mid-level status-quo with regard to the medical component.

ideally I think there would be a 'medical psychologist' track that did away with most of the psychological testing, statistics, etc......they could replace that with pharm and more 'medical' stuff....

you could still have other psychologist tracks that are more traditional.
 
ideally I think there would be a 'medical psychologist' track that did away with most of the psychological testing, statistics, etc......they could replace that with pharm and more 'medical' stuff....

you could still have other psychologist tracks that are more traditional.

So what, exactly, would you throw out (on both sides, aside from the stats and such) and what would the clinical exposure be? What exactly would 'medical psychology' encompass and how much other medical stuff, if any, would you throw in?
 
Flame as much as you want, but a rigorous 5-year doctorate in medical psychology (with physio, biochem, pharma training right from the beginning of the doctorate and not in some crappy post-doc 2-year masters) would be at least an equally efficient alternative to the psychiatric post-MD residency mode IMO (fe.g. economic/supply-demand in relations to quality of services given) l. The reason that it is not applied is due to protectionism/lobbying of the psychiatry occupation and not in relation to some empirical data or scientific rationale.

How would this prepare you in terms of recognizing/understanding pathophysiology outside of primary psychiatric disorders? I'm sure the pathway you mentioned could play its role, but not in a manner that produces equivalent practitioners. It is not about lobbying and protecting the gates; it is very much about educating and training a complete physician, not one solely focused on one system, that is very much not isolated from the whole organism.

I'm not sure you are aware of the breadth or depth of understanding that a physician must attain in order to truly grasp the intricate interplay of physiological processes and the pathologies that could disrupt such processes. I'm only an MS1, but I can tell you that each block that I complete brings about more understanding... but this only highlights how much I do not know... and the more elaborate the puzzle appears. It can be an overwhelming feeling at times. Sitting on the outside, I doubt one can appreciate the importance of this process.
 
How would this prepare you in terms of recognizing/understanding pathophysiology outside of primary psychiatric disorders? I'm sure the pathway you mentioned could play its role, but not in a manner that produces equivalent practitioners. It is not about lobbying and protecting the gates; it is very much about educating and training a complete physician, not one solely focused on one system, that is very much not isolated from the whole organism.

I'm not sure you are aware of the breadth or depth of understanding that a physician must attain in order to truly grasp the intricate interplay of physiological processes and the pathologies that could disrupt such processes. I'm only an MS1, but I can tell you that each block that I complete brings about more understanding... but this only highlights how much I do not know... and the more elaborate the puzzle appears. It can be an overwhelming feeling at times. Sitting on the outside, I doubt one can appreciate the importance of this process.

oh jeeez....this post is precious. How would this prepare you in terms of understanding the pathophys outside of psychiatric disorders? Well.....I don't what your fantasy is of what we do, but I'm not treating osteomyelitis here.

By the time you finish residency(if you do psych), you're not going to remember a lot of that stuff anyways(and thats not a terrible thing).

A first year medical student telling a clinical psychologist about the field is rather amazing...
 
oh jeeez....this post is precious. How would this prepare you in terms of understanding the pathophys outside of psychiatric disorders? Well.....I don't what your fantasy is of what we do, but I'm not treating osteomyelitis here.

By the time you finish residency(if you do psych), you're not going to remember a lot of that stuff anyways(and thats not a terrible thing).

A first year medical student telling a clinical psychologist about the field is rather amazing...

just offering a prospective from my admittedly limited point of view.
 
A first year medical student telling a clinical psychologist about the field is rather amazing...

:laugh:...exactly.

I'm not sure you are aware of the breadth or depth of understanding that a physician must attain in order to truly grasp the intricate interplay of physiological processes and the pathologies that could disrupt such processes. I'm only an MS1.....

Indeed, only an MS1...so you might want to slow your roll, as the kids are prone to recommend these days. I regularly lecture on such topics to medical students/residents/staff and lead/co-PI research as a FT faculty member at a top medical school & residency program. It's good to be passionate, as you'll need that over your next 7ish years if you want to get through, just don't step on toes or it will be a much harder/rougher path.

*edited, as my initial post was too snarky*
 
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inspired by this thread: http://forums.studentdoctor.net/showthread.php?t=984859

some med students believe that psychiatry doesn't belong in medicine and that psychologists with prescription pads are a viable alternative

i'd like to hear from psych residents and attendings about times you had to use your medical school training in your field

in before "everything"

Medical students may be very smart (receiving As in biochemistry, 1 year of Ochem/Pchem/physics/biology and at least 1 year ofcalculus) but don't know everything. Hence residency and fellowship are required where you actually learn to become physicians. I know many PhDs claiming to have high GPAs b/c they never had to take any of these difficult classes.

Psychiatry is one of the core rotations in medical schools so it's not going away anytime soon if ever. Yes, I use what I learned in internship and medical school daily. I and many of my classmates also see patients for therapy. The norm for most of us is the 30 minutes followup and not the 'grinding' type of work someone mentioned earlier. The 15 min med check is not that common as residents and MSs believe. Additionally, these practices will not typically hire residents even for moonlighting. You have to be at least a fellow with a full medical license due to the high risk of liability.

The reason psychiatry appears 'easy' is largely due to the rigorous and highly competitive nature of pre medical and medical training we all excelled in. We don't know just the Y meds but also the physical meds/conditions and how factors x, y, z contribute to the patient presentation in my office.

I agree with another poster with regard to psychiatry appearing easy superficially but very difficult to practice.
 
How would this prepare you in terms of recognizing/understanding pathophysiology outside of primary psychiatric disorders? I'm sure the pathway you mentioned could play its role, but not in a manner that produces equivalent practitioners. It is not about lobbying and protecting the gates; it is very much about educating and training a complete physician, not one solely focused on one system, that is very much not isolated from the whole organism.

I'm not sure you are aware of the breadth or depth of understanding that a physician must attain in order to truly grasp the intricate interplay of physiological processes and the pathologies that could disrupt such processes. I'm only an MS1, but I can tell you that each block that I complete brings about more understanding... but this only highlights how much I do not know... and the more elaborate the puzzle appears. It can be an overwhelming feeling at times. Sitting on the outside, I doubt one can appreciate the importance of this process.

You may be a MS1(a great accomplishment btw) but you have shown more class and intelligence than a few others here on this thread. Good job!
 
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When it comes to "sense of wonder/engagement", my personal anecdote is that psychiatry went from being a distant consideration to a clear front-runner in the field I wanted to pursue simply because my attending was so great. Residents were very good, if not spectacular. I contrasted that with the incredibly mediocre experiences I had had on my Neurology and Heme/Onc rotations, a full month each at one of the top 10 children's hospitals in the country - the attendings on those services were decent, even good, but psych blew them away in terms of teaching, interesting cases, patient interaction, and so on.

Admittedly, not everyone will have this experience. Clearly I had an excellent psych attending and had at least some background level of interest in the field before my rotation. But I believe it is cynical to say that psychiatry doesn't inspire the same interest and level of engagement that other specialties do - it just requires the right person to be interested. I have good grades, clinical honors on several rotations, multiple publications and excellent Step scores. Psychiatry is my field of choice not because it's easy or because it's what I have to do, but because - as others have mentioned, and as my own experience reading this board has reinforced - it's very engaging and is difficult to do well. Plus, I feel I have the ability to find a good residency and replicate this type of experience for myself.

That being said, the role of other providers in the field (to veer back to the actual topic for a moment) isn't something I am personally well-acquainted with. Until we have good head-to-head data on outcomes with different providers in statistically similar patient populations, I take all of these proclamations about what would be an acceptable alternative with a grain of salt. I worked on an inpatient unit (which is by far what I am most interested in doing), and I certainly feel that type of work is most suited to providers with a strong general medical background - e.g. MD. When it comes to outpatient practice... again, we need more actual data to go on. And not the type conducted by groups with an agenda, like the "data" demonstrating good outcomes with midwives (because all complicated cases are denied and/or rushed to the hospital so it's no longer their problem).
 
populations, I take all of these proclamations about what would be an acceptable alternative with a grain of salt. I worked on an inpatient unit (which is by far what I am most interested in doing), and I certainly feel that type of work is most suited to providers with a strong general medical background - e.g. MD. .

being a psychiatric hospitalist or mostly inpatient psychiatrist has its good and bad parts. The bad is that you as the inpatient psychiatrist don't really have any say in the patients long term care, which is going to have much more to do with determining the pt's outcome than whatever you do for them on inpatient for 5-8 days or whatever. Even if you are a good psychiatrist, you're going to admit patients who have been mismanaged for a long time, babysit them for a few days(maybe change their meds, but remember you are not going to be their psychiatrist after DC and the new psychiatrist will probably change these), and then discharge them to followup(maybe) with providers who in a lot of cases aren't going to be competent and aren't going to want to do the same things as you.

Outpt psychiatry is generally more popular than inpatient because for many of your patients you do have more real control over their management.
 
The 15 min med check is not that common as residents and MSs believe. Additionally, these practices will not typically hire residents even for moonlighting. You have to be at least a fellow with a full medical license due to the high risk of liability. .

well thats not the main reason...it's more to do with renumeration. There are many grindhouses across the country with agencies who see medicaid only populations.....generally these are owned by psychologists/social workers and they'll employ upper level psych residents to do med mgt for the medicaid pts.
 
ideally I think there would be a 'medical psychologist' track that did away with most of the psychological testing, statistics, etc......they could replace that with pharm and more 'medical' stuff....

you could still have other psychologist tracks that are more traditional.

In all honesty, those are some of the things that are most crucial to our role (and identity) as psychologists. Much of what a psychologist does should have a solid foundation in understanding various principles of psychometrics, just as I'm sure many would agree that much of what a psychiatrist does should have a solid basis in empirical medicine.

I think research and teaching are probably the areas that would need to take the biggest hits if a true medical psychologist track were to ever be created. Particularly after year 2, research is going to be monopolizing most of your time outside of practicum placements. And that's personally not necessarily something I'd like to see.

Given that the current average time to completion (sans postdoc) is edging closer and closer to 6 years, I don't know that any such program would be viable without requiring at least that much time. Although I suppose they could retool the internship year to really hammer home a lot of "on the job" training, perhaps even increasing it to two or three years.
 
In all honesty, those are some of the things that are most crucial to our role (and identity) as psychologists. Much of what a psychologist does should have a solid foundation in understanding various principles of psychometrics, just as I'm sure many would agree that much of what a psychiatrist does should have a solid basis in empirical medicine.

I think research and teaching are probably the areas that would need to take the biggest hits if a true medical psychologist track were to ever be created. Particularly after year 2, research is going to be monopolizing most of your time outside of practicum placements. And that's personally not necessarily something I'd like to see.

Given that the current average time to completion (sans postdoc) is edging closer and closer to 6 years, I don't know that any such program would be viable without requiring at least that much time. Although I suppose they could retool the internship year to really hammer home a lot of "on the job" training, perhaps even increasing it to two or three years.

well ideally this would not be the only track for psychologists....there would be a medical psychology track(which I suspect would be more competitive for compensation reasons) and then something that more resembles the current track....
 
Psychology wants an inroad to the script game--fine. Perhaps some psychiatrists, the psychology premeds come to mind, would have preferred to train in a medical psychology tract.

But to those of us whose identity, thought process, and conception of how psychiatry should be practiced, is firmly rooted in clinical medicine, a hybrid without a 2 way street of communication and curriculum with the mothership of medicine at large is an unconvincing proposition.

I haven't seen any psychologists on the wards on other services. It makes no sense to me to forgo those experiences on the way to being a psychiatrist. It also makes no sense to me to brain drain the psychology realms of expertise to crank out psychopharmacologists with poorer therapy skills and weak medical training.

I have to see what you're proposing in detail.

A cabal comprised of a dissatisfied, uninspiring psychiatrist and some budding psychopharmacologists is not an all star team to be tasked with dismantling a medical specialty. Despite at least 1 impressive resume in the lot.
 
Another thing to consider with respect to psychiatrist vs psychologist being top of the chain is - let's face it - intellectual rigor. I know Visty is loading his shell on this one, but the reality is it's pretty difficult to be a ***** and become a psychiatrist. In fact, it's very difficult to become a psychiatrist without being very highly intelligent. The realities of the road to becoming a psychiatrist demand it. Psychological training is much more highly variable with respect to the quality of the person involved. Sure some of the psych doctorates (I'd need a flowchart to even navigate the myriad ways one earn the title 'psychologist') are very competitive and difficult, but medicine, man, is clearly the most brutal. But rather than turn this into a pissing contest, I'm just saying you have a known brand with a psychiatrist that isn't as present with other mental health professionals. Does that mean all psychiatrists do good work? No. They are fallible creatures after all, with different sets of motivations and exertions of effort, but if we want to talk about averages - psychiatrists win. And everyone wants the best in their time of need.
 
Another thing to consider with respect to psychiatrist vs psychologist being top of the chain is - let's face it - intellectual rigor. I know Visty is loading his shell on this one, but the reality is it's pretty difficult to be a ***** and become a psychiatrist. In fact, it's very difficult to become a psychiatrist without being very highly intelligent. The realities of the road to becoming a psychiatrist demand it. Psychological training is much more highly variable with respect to the quality of the person involved. Sure some of the psych doctorates (I'd need a flowchart to even navigate the myriad ways one earn the title 'psychologist') are very competitive and difficult, but medicine, man, is clearly the most brutal. But rather than turn this into a pissing contest, I'm just saying you have a known brand with a psychiatrist that isn't as present with other mental health professionals. Does that mean all psychiatrists do good work? No. They are fallible creatures after all, with different sets of motivations and exertions of effort, but if we want to talk about averages - psychiatrists win. And everyone wants the best in their time of need.

If you put all the psychiatrists finishing residency in the last 5 years in a bag, and all the PhD psychologists finishing their training in the last 5 years in a different bag and randomly pull one out of each I would say 8 out of 10 times the psychologist is going to have a higher IQ. I went to a top 10 undergrad and there where 4.0 people with publications who ended up only getting into like their 20th choice program. Its wicked competitive to get into a clinical psychology PhD program.

Now if you were comparing psychiatrists to PsyD's then I think the psychiatrist would be higher IQ 8/10 times.

But this means nothing related to who should prescribe medications, psychologists learn how to be primarily be researchers, psychometricians (is that a real word?) and psychotherapists (but really only the alphabet soup therapies, due to the research slant of the field).

This concept of getting rid of MD's in mental health is kind of absurd. Sure there may be ways to train people to treat like 75% of the patients, but there is always going to be patients who are sick enough, have enough other medical conditions, medications,etc. that your going to need an MD to be the one prescribing. So if you completely take the field out of medicine then I'm sure within 10 years we see some sort of fellowship sprout out of another MD field to try to fill that void, which is just silly to have to do seeing as we currently have a field to do it right now.
 
Psychology wants an inroad to the script game--fine. Perhaps some psychiatrists, the psychology premeds come to mind, would have preferred to train in a medical psychology tract.

But to those of us whose identity, thought process, and conception of how psychiatry should be practiced, is firmly rooted in clinical medicine, a hybrid without a 2 way street of communication and curriculum with the mothership of medicine at large is an unconvincing proposition.

I haven't seen any psychologists on the wards on other services. It makes no sense to me to forgo those experiences on the way to being a psychiatrist. It also makes no sense to me to brain drain the psychology realms of expertise to crank out psychopharmacologists with poorer therapy skills and weak medical training.

I have to see what you're proposing in detail.

A cabal comprised of a dissatisfied, uninspiring psychiatrist and some budding psychopharmacologists is not an all star team to be tasked with dismantling a medical specialty. Despite at least 1 impressive resume in the lot.

well I don't think most want an inroads into writing prescriptions.....I was just more thinking of ways to create better practitioners with more efficient training.

and of course you havent seen any psychologists on the wards of other services...that would be a waste. Not completely unlike some of the rotations future psychiatrists rotate through.
 
If you put all the psychiatrists finishing residency in the last 5 years in a bag, and all the PhD psychologists finishing their training in the last 5 years in a different bag and randomly pull one out of each I would say 8 out of 10 times the psychologist is going to have a higher IQ. I went to a top 10 undergrad and there where 4.0 people with publications who ended up only getting into like their 20th choice program. Its wicked competitive to get into a clinical psychology PhD program.

Now if you were comparing psychiatrists to PsyD's then I think the psychiatrist would be higher IQ 8/10 times.

But this means nothing related to who should prescribe medications, psychologists learn how to be primarily be researchers, psychometricians (is that a real word?) and psychotherapists (but really only the alphabet soup therapies, due to the research slant of the field).

This concept of getting rid of MD's in mental health is kind of absurd. Sure there may be ways to train people to treat like 75% of the patients, but there is always going to be patients who are sick enough, have enough other medical conditions, medications,etc. that your going to need an MD to be the one prescribing. So if you completely take the field out of medicine then I'm sure within 10 years we see some sort of fellowship sprout out of another MD field to try to fill that void, which is just silly to have to do seeing as we currently have a field to do it right now.

I agree. It's also important to all of medicine for psychiatry to be a part of it's training.

The more I learn about this field the more I realize it takes a team effort to deliver effective care. Medical doctors, psychologists, social workers, nurses, techs, etc. All of us have an important role.

Some cross training/pollenization makes some sense. I do some basic therapy. Whoever else might do some basic scripts/medicine. (It's the isolation of scripts from medicine that most of our camp thinks is obscene, for very good reasons).

Psychiatric medicine can certainly be improved. Replaced? With what? As you adroitly point out.
 
If you put all the psychiatrists finishing residency in the last 5 years in a bag, and all the PhD psychologists finishing their training in the last 5 years in a different bag and randomly pull one out of each I would say 8 out of 10 times the psychologist is going to have a higher IQ. I went to a top 10 undergrad and there where 4.0 people with publications who ended up only getting into like their 20th choice program. Its wicked competitive to get into a clinical psychology PhD program.

Sorry, but you're wrong.

The reason why those 4.0 people didn't match higher was due to probably the very high emphasis on research and mentor match my friend, not IQ. To get into a clinical PsychD program you need:

- a minimum of 6 courses in psychology, or a closely related social science field, including a course in statistics.
- a high score on the General GRE
- a high score on the Psychology GRE
- Research match. "An important criterion for admission is the fit between student research interests and the research interests of the faculty teaching in the program."

Let's take a specific and very respectable program example: Univ of Mass Boston's Clinical Psych program:
http://www.umb.edu/academics/cla/psychology/grad/cp/admissions

How competitive is it there?
"The Clinical Psychology Program at the University of Massachusetts Boston receives approximately 300 applications a year. From this applicant pool, we undertake an extensive review of applications and invite 35 to 40 people for a day long interview. "

13% of applicants get interviewed for this Clinical Psych program.

Now let's see what you need for medical school:

What's required?
- As in premed classes: organic chemistry 2 semesters, biology, biochemistry, general chemistry
- a 32 or better on the MCAT, the most difficult entrance exam into graduate school
- research
-community service

Now let's look at a respectable medical school: Northwestern Feinberg School of Medicine.

http://www.feinberg.northwestern.edu/admissions/process/class-profile.html

The 161 members of the Class of 2016 entered their first year of medical school on August 8, 2012. The class includes 96 men and 65 women. They were selected from a pool of 6,910 applicants.

2% end up matriculating at this medical school !

135 students received academic honors. Forty-five members of the class achieved Phi Beta Kappa honors; 83 students graduated with Latin or honor society recognition; and 86 students received a scholarship during undergraduate school, two were National Merit Scholars and one was a Presidential Scholar.
 
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