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Advice Please: Switching from PhD to MD

Discussion in 'Psychiatry' started by edieb, Mar 6, 2007.

  1. edieb

    edieb Senior Member

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    I am in my fourth year of a Ph.D. clinical psychology program and have decided that this field is not really for me. You are so limited with what you can do with a Ph.D., especially clinically. In addition, although it is really, really hard to get into graduate school (acceptance rates of about 2-4% for a clinical PhD program) there is a HUGE oversupply of psychologists, probably because of the creation of the Psy.D. degree I guess my main question is that I still have 2-3 years to finish my degree (1-2 more years of grad school + internship). So my questions for you are the following:

    1 - I don't want to wait 3 years before I start pursuing my MD; I would rather leave now with just a Master's degree rather than wait 3 years for a doctorate which I don't plan on ever using (I want to do private practice). Is this wise?

    2 - I am 31 years old. Considering I will probably have to take 2 years of undergraduate courses before I actually apply, will I stand out (i.e., be put at a huge disadvantage) in med school?

    Thanks
     
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  3. sunlioness

    sunlioness Fierce. Proud. Strong
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    The oldest person in my med school class was 40. My own psychiatrist went to med school in her 40s as well. It's unusual, but not THAT unusual. What you really have to weigh is if your desire to be a doctor outweighs incurring that much debt (my med school debt is over $200,000) with less time to pay it all back than the fresh-out-of-college people have. Also realize that if you already know you want to be a psychiatrist, it's going to be HARD to get through those surgery and medicine rotations. But if it's really your dream, then go for it!
     
  4. i61164

    i61164 Polar Bear, MD

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    I don't think your age will hurt. I too am 31 (MS2) and I have a few classmates that are older than me. I guess it is a disadvantage in terms of career length (and paying back loans), but it is an advantage in other ways. Having extra "maturity" is good in med school. You will likely be more responsible than someone who just spent 4 years living in a frat house. You may also be somewhat distanced from the social life of your class which keeps you away from all that gossip and backstabbing. Plus, people do not want their doctor to look too young, so the more grey hair you have the more your patients will tend to trust you.

    As far as the PhD goes, I don't think I would want to finish either. It just seems like it would be too painful to spend all those extra years if you are not going to use it. On the other hand, med school is painful too (think Biochem). From what I hear, most PhD students consider quitting sometime around third year (after prelims?). Some people stick it out and are happy in the end, so maybe this is something that will pass if you stick it out. But if you really have to get an MD, I don't think it's worth taking all that extra time to get the PhD. But, make sure you gets lots of clinical experience before applying to med schools so that you can justify why you want to make a switch at this point.
     
  5. jjbmsiv

    jjbmsiv INTJ

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    Med school is a looooooooooooong road to hoe. The idealization of doctors that you find on TV is NOT the reality of practicing today's medicine. At the same time, I know the misery of showing up to a job, or to school, doing something you absoultely hate day in, day out, and what misery and contempt that brings to your life, and your loved ones. If that is the situation, and you dream of doing medicine, then you will be successful. Good luck!
     
  6. 50960

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    I know your interests a bit, and I would say go for the MD....
     
  7. Adam_K

    Adam_K Indentured

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    If you are miserable at what you are doing now and are 100% sure that you wish to go the long, hard road to medical school and residency, by all means, go for it.

    Although, I was just a bit younger when I left my corporate job and some parts of medical school simply weren't for me :)eek: surgery flashback), I'm going through the match now and will soon know whether I have a position.

    If there is anything I would caution you against, it would be to try your hardest to get into a US school, whether MD or DO. I went abroad and though it has gotten me to my goals, it is not something I would recommend because it will limit your opportunities.
     
  8. strangeglove

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    I would say go for medical school. There are many non-traditional students who are your age. However, I would also recommend that you finish your PhD. It seems like 1-2 years is a lot, but it's not really that much in the larger scheme of medical training. Perhaps you can skip the internship year (though I understand that at many programs, this internship is actually a requirement for the PhD). I would say that having a PhD in clinical psychology would put you ahead of most psychiatrists in terms of training in therapy, as well as training in research. I suspect that having a PhD would be looked upon quite favorably by medical school admissions committees, as well as those who might give you a job down the road. A masters, on the other hand, holds very little value in the academic world. Also, you don't want to come across as someone who can't finish what you started (most people in academia know that a masters degree in psychology or basic science usually means an incomplete PhD).
     
  9. Anasazi23

    Anasazi23 Your Digital Ruler
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    Is this a joke?

    Aren't you the one that was touting all the praises of psychologists prescribing, the supposed great job outlooks and whatnot?

    I'm not saying I disagree with you...I left Phd school for the same reason and have never looked back.
     
  10. whopper

    whopper Former jolly good fellow
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    You don't necessarily have to go to medschool.

    You could go to nursing school, eventually get a masters in nursing and become a nurse practitioner that can prescribe meds while at the same time using your knowledge with your Ph.D.

    A psyche Ph.D. guy I know is doing this, and if I had my own practice I'd scoop him up. He's very knowledgeable and I would love to have a psyche Ph.D. working with me to help me with the psychotherapy stuff.
     
  11. Doc Samson

    Doc Samson gamma irradiated
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    sigh... what has psychiatric training become?
     
  12. sunlioness

    sunlioness Fierce. Proud. Strong
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    I'm gonna do my own psychotherapy stuff. :) I think a lot of people just don't have an interest in it. Or else find it intimidating, which it kinda is.
     
  13. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Or there are those of us who do enjoy our patients, but simply find 20 minutes of complaining PLENTY long enough to endure ... :sleep:
     
  14. Anasazi23

    Anasazi23 Your Digital Ruler
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    If by "help," you mean taking the many patients who are requesting therapy, but because you are the treating doctor, don't have the time or desire to see, then I understand you.

    If by "help," you mean actually helping you with your psychotherapy, then you've bought into another perpetuated myth that psychiatrists are unable to perform psychotherapy.

    "People" like to compartmentalize, and create ridig dichotomies to make themselves feel better. You don't have to buy into it.
     
  15. whopper

    whopper Former jolly good fellow
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    This is coming from a guy with a bachelor's in psychology.

    A Psychology Ph.D. can vary. Remember Psychology is the study of all human behavior, much of it has nothing to do with pathology. For example someone can have a Ph.D. in psychology and choose to work in ergonomics or corporate psychology.

    However, a psychologist with a Ph.D. who's read several texts (hundreds of pages) on psychotherapy, possibly even written a few texts, vs most psychiatrists who have only basic psychotherapy training.....

    Hmmm....

    Some patients would benefit from some very in depth psychotherapy which managed care will only pay for from a psychologist, not a psychiatrist. For that patient to get it from a psychiatrist, they're going to have to pay out of pocket.

    Not trying to perpetuate anything, a psychology Ph.D. who's chosen to truly specialize in treating mental illness is going to have training in areas we don't have.

    For example, how many of you can do an MMPI for real? I'm not talking just a superficial, "I know what that test is". Would you actually do it? If an MMPI suggested a patient was malingering, how confident would you be with those results? If you're like most psyche residents, and attendings we only know of what we read of the MMPI and we only study that for the board exam and a few lectures. I have yet to see a psychiatrist give one and this is working in over 10 hospitals.

    So if that Ph.D. psyche guy was working with me...and I had a potential malingerer, hell yes I'd ask my buddy to check that patient out and reccomend an MMPI, which is something he is very able to test, score & interpret.

    Other examples I've seen---neuropsyche testing for brain damage--a field we don't often delve into, personality disorders, condition therapy for phobias...(How many of you flooded a patient?).

    Bottom line: nothing to do with lack of desire. All to do with giving patients what they can afford and working with those who have better expertise and training in their respective fields.
     
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  17. Doc Samson

    Doc Samson gamma irradiated
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    Psych testing is absolutely the domain of psychology. I refer to psychologists for psych testing, and greatly appreciate their help in interpreting the results, but psych testing is not psychotherapy. I don't care how many texts you've read or written about psychotherapy - practical experience is the key. Depending on the psychiatry residency or psychology program you might be training at, there's every possibility that a psychiatrist might have had just as much (or perhaps more) "face time" with patients doign psychotherapy as a psychologist (especially since we don't have to spend any time doing research).
     
  18. Adam_K

    Adam_K Indentured

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    Hallelujah!
     
  19. whopper

    whopper Former jolly good fellow
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    double post sorry
     
  20. whopper

    whopper Former jolly good fellow
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    True, a point that should've been clarified.

    Don't agree though on all forms of psychotherapy. Some can be learned through practical experience. Others though IMHO do need study. There's plenty of theories and approaches in this field than only be learned through study, not face time.

    (Just my opinion, I think the practical benefit to studying psychodynamics from texts at some point hits the law of diminishing returns. After you've read maybe the 5th 100 page text on a different person's approach e.g. Jung or Freud you start seeing it as just someone else's theory, but the first 3 were very insightful-in a manner where it would make a better psychotherapist.

    Face time--yes that too hits the law of diminishing returns, and book knowledge without face time is not good either.

    If anything--my broader point is that psychiatrists should be studying more psychotherapy--to a point where it'll reach that high point in the learning curve, but the reality is programs are not emphasizing this, nor is managed care. Samson you are right that programs vary--but I am also right in pointing out that several programs aren't teaching psychotherapy as much as they should.)

    A psychiatrist can of course be highly skilled in this area too, and more so than a psychologist. Some psychologists don't have much training in clinical work, and have chosen to specialize outside mental illness. Of course anyone in this field will be a better healer if we try to master everything possible to help our patients.

    However, and this is part of the problem that some of the other posters have brought up for example the "myth".

    Comparmentalizing whether we like it or not is a reality. Not because it makes our lives easier. Actually for me its a bit frustrating to sometimes not know what the assigned psychotherapist is doing while I prescribe meds. If it were my choice I'd want to spend an hour with each patient and do psychotherapy with them.

    Its a reality that is imposed upon us by managed care unless you choose to have your patient pay out of pocket.

    And that reality is shaping our training. Programs are teaching psychotherapy less. The emphasis in this is declining.
    If anything, and given what I've seen from people's responses, we then should at least be doing what we can to question if at least not stop this trend.

    And yes--(and we'll have to choose to disagree on this), I'd still love to have that guy I mentioned for reference if we practiced together. A simple ring to his office and I could ask him for some insights where he had training in areas we haven't.
     
  21. Anasazi23

    Anasazi23 Your Digital Ruler
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    Actually, it's been proven that in recent times, residency programs are teaching more psychotherapy. In fact, it is now an ACGME requirement in psychiatry residency to have 'core competencies' in various forms of therapy. A recent study, admittedly with flaws, outlined that psychiatry residents have more hours of psychotherapy training than psychology grad students - or something to that effect.

    There are endless symposia, lecture series, continuing ed classes, etc., whereby a psychiatrist can learn additional therapy techinques and core skills. Nobody is preventing anyone from doing this if they desired.

    Maybe it's because of where I do my training (east coast), but I'd estimate taht at least 75% of the psychiatrists I know are actively engaging in psychotherapy in their practices. And certainly, nobody is going to tell them that their brand of psychotherapy is inferior to anyone elses, regardless of degree or training.
     
  22. 50960

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    Back to the OP, I would have thought you would be more supportive Sazi. No zealot like a convert I guess......... I think it is coll he/she is thinking on med school and really has nothing to do with how he/she views the job market of a psychologist, but that this person is unhappy with what he/she is doing as you were.
     
  23. sunlioness

    sunlioness Fierce. Proud. Strong
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    I have absolutely no desire to do neuropsych testing. I'm glad it exists and I am glad there are people who do it, but for me? What a snore. :) Therapy is something different entirely.
     
  24. sunlioness

    sunlioness Fierce. Proud. Strong
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    We have several classes in psychotherapy in my program. Don't know where you are, but it's unfortunate if you don't have it.
     
  25. sasevan

    sasevan Senior Member

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    I'm a PsyD that's been accepted to DO school and will be pursuing psychiatry, but I don't believe that a psych PhD/PsyD is all that limiting (except for maybe psychopharmacotherapy) nor that a psych MD/DO is without any limitations (psychtesting). I decided to switch because during my psychology residency I realized that medicine was a better fit for my clinical interests; however, I realize that I will be changing one set of limitations for another.
    My advise is to get clinical psychology experience where you'll be interacting daily with psychiatrists and other physicians (such as at a major medical center) to see if in fact your clinical interests are better served by pursuing medicine. If you have already had that exposure and you believe that psychiatry is a better fit for you then by all means go for it.
    BTW, it'll probably take 2 years to complete pre-med and 1 year to apply/interview (glide year) before matriculation.
    P.S. While having a PhD looks good in the application I can't see you going for an indefinite amount of more years (dissertation approval can be a very uncertain process) in one field when you want to switch to another; not to mention the loss of potential income. I also don't see any problems at all with your age. If you do switch, WELCOME!!! :thumbup: There are a number of psychologists turned psychiatrists in the field (3 at my med ctr) and a few right here in the forums.
     
  26. maranatha

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    My experience from the interview trail is that this is true. UPitt, for example, has a reputation of not teaching psychotherapy, but this has dramatically changed in the last few years and is simply not true anymore.

    I know a few psychiatrists that wanted more training and easily found it. The Beck Institute, for instance, offers advance training for any professional desiring to do so. Also, most major cities have a psychoanalytic institute that always offers advanced training. I've been asked why I put Hopkins high on my ROL given my interest in therapy and I usually state what Sazi said.
     
  27. whopper

    whopper Former jolly good fellow
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    You may be right, I was basing my data on anecdotal information, though perhaps with a different reference. Psyche attendings generally state that years ago, psychotherapy and training in it was much more emphasized than it is now. The advent of safer meds such as SSRIs and atypicals (which actually aren't much safer per CATIE, but at least the perception that they were safe had arisen) had caused a shift from psychotherapy to medication.

    I'm not sure if we're talking about the same thing here which may be a point of misunderstanding. Pretty much all psychiatrists I know ofer supportive words for their patients. I guess this could be interpreted as psychotherapy, and for that matter all doctors do that psychiatrists or not. When I was using the term, I meant use of psychotherapy in a more formal, manner, such as actually using CBT, psychodynamic, or DBT for example with an intended use of the therapy for an intended result. Perhaps it is different in your location, but in my area in NJ seems like the former is a minority, while pretty much everyone gives "brief supportive therapy".

    I too am on the east coast, and yes we also do get psychotherapy training, though the psychotherapy in outpatient is somewhat limited due to the managed care issues. Being a resident has allowed the attending & I to allow for more psychotherapy because each of us now have 2x more time to sit with each patient.



    Anyways, looking back on the this thread, I apologize for a few statements here and there that lead to misinterpretation, and I also appreciate the data you've given Sazi.
     
  28. Anasazi23

    Anasazi23 Your Digital Ruler
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    No need to apologize, we all are entitled to our thoughts and opinions here.

    And, about the form of psychotherapy I know my attendings practice...it's almost (but not entirely) traditional psychodynamic psychotherapy.
     
  29. 50960

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    So in your opinion you could treat someone with OCD by using psychodynamic therapy, or your attendings could?? I do not see the wisdom there. Obviously meds are often needed, but so is exposure and response prevention focused CBT. How can your attendings teach this?
     
  30. Anasazi23

    Anasazi23 Your Digital Ruler
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    I am supportive. I'm frequently helping folks through PMs who want to change to psychiatry...either from psychology or medical field.

    He/she was talking about a "HUGE oversupply of psychologists" in the original post. That's where I got the assumption that job market was something that was on edieb's mind.
     
  31. Anasazi23

    Anasazi23 Your Digital Ruler
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    They treat lots of OCD, prescribe meds, and have CBT skills. So, they use all these options available to them to treat. Incidentally, psychodynamic psychotherapy can also treat OCD when done properly. This dates back to classic Freudian literature.

    It's not rocket science to come up with behavioral extinction plans, keep anxiety journals, and such. They can and do teach it, as do psychologists.

    You touch on another subject which seems to be a perpetuated myth...that the majority of patients coming in have a regimented disorder that is only treated through a specialized therapy technique....OCD is the common example. Statistics show, quite unbelievably to me, that simple phobia is the most common psychiaric complaint. That isn't necessarily what shows up in the office, however. Not to say, of course, that it doens't exist...as we all know it does....but OCD is completely treatable by a psychiatrist.

    I think most of us would agree that those with disabling OCD have other "issues" as well that are likely contributing. One could argue that attacking the problem in a more sterile, CBT fashion may also not be the most efficacious way to treat the patient.

    Just my thoughts.
     
  32. raspberry swirl

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    i just wanted to interject into all this blabbering, that the above post is a wise and to-the-point post, and the best thing said so far on this particular thread, and you all just glazed right over it in order to get your last words in. its always nice when we truly focus on the concerns of the OP who is no doubt struggling with this decision... i would just add that there is no perfect profession, and if you think getting a medical degree will get you that, you will likely be somewhat disappointed. always remember that upon completion of any degree, you are able to tailor your actual work towards the setting and clients that interest you the most. med school sucks and its expensive and will likely ruin at least one relationship in your life. if you choose to do it, make sure your heart is truly 100% committed.
     
  33. i61164

    i61164 Polar Bear, MD

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    I disagree that you will be limited with an MD/DO. Just think of all the different groups of crazy patients that you can work with in the following specialties:

    Psychiatry (of course)
    Emergency Medicine
    Plastic Surgery

    See how with the MD/DO you can go it from any of these different angles? Talk about flexibility. And you don't even have to choose until 4th year so there is plenty of time to make your decision. I mean, do you guys think that not doing psych testing yourself is really a limitation?

    I think if you go into Family Medicine you can do pretty much anything you want including OB, surgeries (minor ones), derm, GI (colonoscopy), lots of psych, and the list goes on and on.
     
  34. edieb

    edieb Senior Member

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    No, for some reason the excess of PhDs never sank in till this year...Probably because my school is nearly 100% research and very isolated, I have had little chance to see what the real world is like.... I have 3 friends from my program ahead of me, all 3 did internships and post-docs at Johns Hopkins and none of them can employment! Additionally, two interns at my site are either having trouble finding post-docs that pay well (one is competing for a $28K post-doc). In addition, there are 700 or so unmatched people this year.
     
  35. edieb

    edieb Senior Member

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    No, for some reason the excess of PhDs never sank in till this year...Probably because my school is nearly 100% research and very isolated, I have had little chance to see what the real world is like.... I have 3 friends from my program ahead of me, all 3 did internships and post-docs at Johns Hopkins and none of them can find employment (and their standards are not that high)! Additionally, two interns at my site are having trouble finding post-docs that pay well (one is competing for a $28K post-docs; the other is staying at my my site [the armpit of hell] and making $70K for post-doc). In addition, there are 700 or so unmatched people this year. It seems like psychology is a sinking ship...

    It is definitely not all about money; however, i do want security.
     
  36. sunlioness

    sunlioness Fierce. Proud. Strong
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    In my program, we are also taught by faculty psychologists. Is this unusual?
     
  37. 50960

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    I hope not as we get alot of training psychiatrists never get, and it is not just testing.
     
  38. toby jones

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    I'm sure psychiatrists get a lot of training that psychologists don't get and that psychologists get a lot of training that psychiatrists don't get and that what training you do get (in either field) depends on the program etc etc.

    It would of course be ideal if we could learn everything about everything but I guess time is limited at the end of the day. One has to focus. Good for me to know that different programs have a different focus. I'll make sure I factor that in with respect to where I apply to. I'm happy to take time away from the bio stuff in order to do more of the therapy stuff.

    :)
     
  39. Anasazi23

    Anasazi23 Your Digital Ruler
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    Well, it seems that you've had a revelation. Does your graduate program know that you feel this way? They certainly won't be pleased, and will likely sabatoge your attempts to get away into the medical field.

    If you're determined, it won't matter - you'll likely encounter a lot of cold-shoulder and jealousy when you reveal this to your program. At least that's what happened to me. Hopefully you'll have a smoother transition.

    There are a few here that have recently done the post-bacc thing and have applied and got into med school. It's a long and painful process, but worth it in the end, in my opinion.

    I never regretted my decision to leave, and personally would have felt that I was missing the most important part of my interests within the approach to the psychiatric patient....vis a vis the adoption of the medical model and approach to treatment. You'll find that it's likely much more compact, more concrete to some degree, and that the satisfaction of making a good diagnosis and seeing tangible results quickly with all the medical tools available to you is a satisfying thing. Medical school forces you to forever look at the patient as a whole - as a physiological being. Combining this with good psychiatric training, interviewing skills, development of clinical/medical intuition, strong observational skills, and combining that with comprehensive medical knowledge makes for a thorough approach to the patient.

    Of course the training and workload completely sucks at times, and you'll discover new meanings of pain and have nights that you're so tired, your face will hurt...but that's all part of the ballgame. That which doesn't kill you makes you stronger. :)
     
  40. edieb

    edieb Senior Member

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    Anasazi, what year were you in when you left grad school? DId you just move home and take the pre-reqs?

    As far as your comment and question about telling my advisor, I am not going to tell him the real reason why I am leaving the program. I see no reason to inspire vitriol in him. Rather, I am just going to say that I am pursuing other options. Sometimes the quiet, peaceful way is the best way...

    I hope I don't sound like I am bashing clinical psychology; it has a lot of good points. However, the degree seems to confer with it a lifetime of struggles. For instance, you cannot live where you want to with a PHD, you have to go where the job is...
     
  41. 50960

    50960 Guest

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    Sazi, I agree with your post, and that is why I am a big advocate for change in my field rather than just leave it. I totally get why people do, as the APA and organized psychology is a total joke, but they have alot of political power. There is a rumor that the APA's are working on a compromise in the political arena, and as much as I hope this happens i dread it as well. As the new pres candidates come around there is pressure for psych to unite and look like we give a ****e about the patients more than our own egos and pocketbook. Both APAs are heavily in the Demo pocketbook, and vice versa. I think things are about to change. Edieb I wish you luck...you will make a good physician.

    :cool:
     
  42. Anasazi23

    Anasazi23 Your Digital Ruler
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    I was a few months into third year, I believe, when I decided I wanted out. Like you, I had my eyes on my Master's so that I didn't leave with nothing.
    Incidentally, it gave me lots of essay fodder and interview topics to speak of, since my "schtick" was to tell interviewers for med school that I wanted to become a psychiatrist. It seemed more interesting to them than the typical "my father was a cardiologist, therefore I must be one," theme.

    I hope it's this easy for you, but know that they'll press you, and want to know a specific reason why you're leaving. I would think this might be less-so if you were a first or even second year grad student....but a fourth? They're not going to be happy, and will disguise it in the guise of "tell us what we need to do better." Of course, you won't fall for that.

    I remember telling a girlfriend I had at the time..."I'm not in the mood to be a pioneer."

    I think that I was referring to what you're alluding to. Psychology is a great field for the right person. That person wasn't me.

    I liked the stability and feel of medicine and harder science than that of psychology. I was routed for neuropsychology, but that field, as interesting as it can be, seemed riddled with the same stuff that plagued most of the other aspects of the profession...

    Anyway, I'll reiterate what some other posters have said. Med school is no joke. It' much more arduous than graduate school was, in my opinion. You have to be certain that the heartache will be worth the reward for you. You said you're 31 years old. I'm 32 now and will finish residency in a year & change...and I fell like I'm a little behind. If you take 1-2 years of post bacc stuff and MCATs next year, then a "slide year" to apply, then four years med school, and four years residency, that'll put you at about 42 years old when you START to practice independently...41 if you cram in post bacc stuff in a year, which is hell (trust me), but do-able.

    Just something to think about...
     
  43. whopper

    whopper Former jolly good fellow
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    This was actually the point I was trying to (rather poorly!) make.

    While everything said by my psychiatry colleagues is true--that of course you can learn things at extracurricular lectures, read texts on your own, etc and while psychiatrists can of course know psychotherapy even better than psychologists....

    The structure of the 2 fields in training differs. YEs there is overlap and variablility, but get 100 psychologists vs 100 psychiatrists and there will be things one group tends to know significantly better than the other that is practical with clinical therapy.

    I got no problem asking someone who knows more than me about something if it helps my patient, especially if managed care forces us (myself & the patient) to do so because that is all the pt can afford.

    If you ask me, if there are psychologists in your teaching faculty in your residency program you're better off. The more diversity you can add to your training the better. (and yes--I'm not trying to suggest that psychiatrists shouldn't know psychotherapy, we should know it.)

    Same boat here, though I'm a year older.
    Went through 3 failed relationships that could've lead to marriage, lost contact with some very good friends, missed 3 weddings because of medschool.

    I felt medschool actually was kinda like jail. Its tough. Did grad school before medschool and grad school was nothing compared to the difficulty medschool was.
     

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