career advice

[cynthia08]

Hello all
I have a friend who needs advice. (I actually am going to vet school but doing him a favor by posting this.) He has a degree in chemistry and is teaching high school science right now. He primarily wants to do counseling but does not want to go to grad school. His main question is how plausible is it for him to go to med school for psychiatry but primarily focus on counseling for things like anxiety/depression/mood disorders in his future practice. Also how necessary is a phd in psych as opposed to a masters in counseling? Any advice would be greatly appreciated!

 

[john182]

Hello all
I have a friend who needs advice. (I actually am going to vet school but doing him a favor by posting this.) He has a degree in chemistry and is teaching high school science right now. He primarily wants to do counseling but does not want to go to grad school. His main question is how plausible is it for him to go to med school for psychiatry but primarily focus on counseling for things like anxiety/depression/mood disorders in his future practice. Also how necessary is a phd in psych as opposed to a masters in counseling? Any advice would be greatly appreciated!

I would say first and foremost that you don't go to med school to "be a psychiatrist" or "be a surgeon". Anyone who says that they've only ever wanted to be such and such is few and far between. Go to med school to become a physician - someone studied in the basic clinical sciences of the human body. Afater that, you go to a field of interest to you.

If your friend is interested in counselling, then perhaps he should be become a counsellor?

You don't "focus" on anything for quite a while. You become a general physician first. You learn about Addison's and Cushings, about gallbladder anatomy and splanchnic innervation, etc., . You do not do medical school to become a counsellor. There is no choice and it's why psychiatry is based firmly in physical disciplines so it's a bad idea to recommend someone got to med school to become something they won't know about for years. Perhaps he might like surgery while on that rotation? Or ophthalmology?

It's been done to pre-decide what you are going to do but it leads to bias IMHO. If he is teaching chemistry, I'm sure he'd ace psychopharmacology but first he must learn basic pharm all over again but in a new and general way towards all medical specialities. It's the discpline and ways in which med school teaches is the same so be sure to be right before making a big financial and time (> 8 years) investment. There are easier ways to get involved if he wants to "counsel" directly.

Psychiatrists don't counsel. It wouldn't be a good use of their time and they are not trained to do so.

I don't know anough about PhDs but I know over here that MDs are common (that is, the post grad research degree, not the US basic medical degree) and a lot of people do them for getting speciality posts, esp in teaching hospitals and research institutes.

 

[worriedwell]

To be sure, a good psychiatrist has a good understanding of the different therapy modalities. That said, psychiatrists are definitely not counselors. Some believe trends in healthcare are sending psychiatrists further away from talk therapy and more into pharmacology, medical management. To be sure, they do much more "counseling" than any other field of medicine, but it is still very much a field of medicine and in fact increasingly being medicalized. The biopsychosocial model of psychiatry starts with bio, and most psychiatrists cannot neglect that aspect.

There are a few (and a dying breed it seems) who do psychoanalysis, or at least are trained in it, and they do extensive talk therapy while sometimes still prescribing medicine. however, this commitment is substantial as it is 4 years med school, 4 years residency (of which the first year is mostly internal medicine and neurology, and the second year is mostly inpatient psych and ER where you aren't really dealing with straight counseling, and then finally third and fourth year are some combination of talk therapy and pharm), and then at least 4 years and some say about 1/2 a million bucks to invest into being a full blown analyst. Some others may do a 2 year fellowship in psychodynamic theory after residency and then deal predominantly in private practice with high functioning anxiety patients and the like.

In order to be a "counselor" type as a psychiatrist, you'll probably have to go the route of private practice in a major city (New York is probably the most amenable to this) where most of your patients can afford to sustain you with out of pocket financing (read: wealthy) such that you can maintain a good standard of living (if you are into that sort of thing). That will take you gradually further away from the bio part of the equation, and some people frown upon that but others love that idea.

Many psychology phds will express that they are much better trained in counseling patients and they are mostly right, but you can make some of that difference up with post residency fellowships in certain therapy modalities. And at many residency institutions, you get a very solid outpatient therapy training in the last 2 years.

But the key here is that med school is not something to just do for kicks...its very demanding and some say residency can be even worse. I would tell anybody who asked me if they should go to med school..."No, I don't recommend it (proceeding to selectively tell them all the negative things about med school" and if they still were dead set on it, then they are supposed to go to med school. Otherwise, do something else.

On the other hand, being a primary care doctor can be an extremely fulfilling role where relationships are developed long term and much counseling adn treatment of basic depression and anxiety may go on (if your a good doctor). The problem is, you can't see any patient for more than fifteen minutes.

 

[worriedwell]

Let me be clear that there are a ton of psychiatrists who focus on anxiety, depression, and mood disorders in their outpatient practice...but they rely heavily on psychopharm these days with varying levels of therapy. But getting there is the part that is no joke, and a process that is arguable more rigorous, and further away from what your friend likes to do (counseling). The one thing you don't have to do going the medical route is research though, so if that is what is prohibitive and the science and clinical training are easy for this friend, then maybe it is a good idea.

 

[willow212]

I believe that social workers can get licensed to do pyschotherapy. It seems that would be a quicker route to a career in counseling.