Career path advice...at a crossroads

[LupaCupcake]

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Hello, this is my current situation:
Bachelor degree with a psych major, bio minor , 3.8 GPA and some lovely honor societies/deans list/volunteered to help new students etc. What most people on this site probably have.

I started working as a Psychiatric Technician on an adult inpatient unit then moved to the adolescent inpatient unit. I did that for a year. I am now the Patient Advocate for our entire hospital, been doing that for 4 months. We are an acute facility that is mostly inpatient although we do have a relatively new outpatient unit . We are mostly adults with one unit for geriatrics and one unit for adolescents. I love this field, I am passionate about it.

My original plan was to be a Psychiatrist. I still need my physics/chem prereqs. I am also a mother to a 7 year old and most likely I will soon be a single mother due to my husband wanting a divorce. Soo...that adds another element of chaos.

I started thinking, what do I love? What do I want to do? What do I loathe? I DO NOT want to push meds and see patients for 5 minutes. That irritates me. I enjoy talking to them, I enjoy doing group therapy (was my strong suit as a technician along with de-escalation of patients). I want to sit down and talk with them, not just write a prescription and say have a nice day. I know not all Psychiatrists do that, but unfortunately it happens a lot. I am at a crossroads and unsure which path to push towards.

Many of you if not most know this field better than me. So I turn to this forum for un-bias advice.

Any advice or words of wisdom would be appreciated.

 

[KillerDiller]

That's definitely a tough one. You've had experience now in a couple different units. Any ideas yet about what type of population you want to work with and what type of setting you want to work in? The psychiatrists I know who do more therapy-oriented activities are in private practice--not so much in hospitals.

 

[smalltownpsych]

My opinion is that if you love the idea of working with people and practicing intensive psychotherapy whether in group or individual, then a degree as a clinical psychologist with solid research experience makes for the best practitioners. IMO we are the experts. Others may disagree. 🙂

 

[edieb]

If you would like to do psychotherapy, whether it be individual or group, get your MSW and then become licensed as a clinical social worker. The vast majority of places that want therapists don't even hire psychologists; rather, they use master's level clnicians.

 

[AcronymAllergy]

You know, I've begun wondering if by frequently steering folks toward the MSW if "all" they're interested in is providing psychotherapy, we're ultimately doing a disservice to psychology in the long run. For one, it essentially sends the message that we've given up any claim to being the "premier" providers of psychotherapy. Also, I've known quite a few folks who developed numerous additional interests in the course of graduate study that hadn't come up beforehand simply because they had no idea those sorts of roles and responsibilities even existed. And beyond all that, who better to work in developing new therapies and studying the efficacy of current ones than folks who have a strong initial interest in delivering it?

Sure, the market for psychologists could be better. But I don't know that steering folks out of the field is the best way to potentially fix that.

To the OP: As you've mentioned, you can certainly deliver psychotherapy as a psychiatrist, although you're likely to start training in it from day one as a psychologist. Personally, the more I work in the field, the more I dislike the way in which medication and a medical model-based explanation are frequently pushed as the first and essentially only viable solution to treat mental health conditions. Even when folks give lip service to the idea of a "biopsychosocial" concept, again, it ultimately comes down to a decision about which medication and potential side-effect profile would be best for a particular patient's problems. And I often feel this isn't the best way to treat the underlying problems.

I will say that if you opt to go the psychology route, you should have some semblance of interest in research, which (if you haven't done much up to this point) could be something as small as being genuinely curious about the world and enjoying the process of asking questions to which you don't know the answer.

 

[thewesternsky]

I agree with edieb on this one.

OP-- You say we know more about this field than you do, and maybe that's true. But don't discount your own knowledge and experiences, especially if you want to continue to work in the settings or with populations (e.g., inpatients) that you already have experience in. When you look at the professionals you've worked with-- which of those jobs do you think you'd be happiest doing?

For what it's worth, my experience is that the vast majority of clinicians doing therapy on inpatient units (individual or group) in hospitals, in particular, are MSWs. But YMMV.

 

[smalltownpsych]

My experience on inpatient units (four different places in three states) has been that psychologists provide individual and group psychotherapy and the MSW's do discharge planning and coordination of services. Some of the social workers resented not being "allowed" to do therapy at these settings.

 

[smalltownpsych]

Also, my experience has been that psychiatrists make about 4 of 5 times the amount of money compared to a psychologist and that a psychologist makes about twice what a social worker makes. Some days I will regret my decision to become a psychologist and not psychiatrist, but then my wife will point out how I am doing what I love and what I always wanted to do and that helps take the sting out of it when I watch a psychiatrist drive by with their new Ferrari and I get into my 10 year old truck!

 

[LupaCupcake]

lol smalltown. I would never get a Ferrari, I would prefer an economic car that doesn't drain my account with gas ^^ I did research on the money aspect....you are right....I am someone that likes to live slightly below my means and aggressively save money. I would rather have thousands saved and a couple hundred in checking than the other way around. My husband err ummm...I don't know what to call him since we are separated but not legally divorced yet.......well, this should make sense to you...he is bipolar...I am sure you know how money does in the hands of a person in a manic state lol. ANYWAYS.

At my facility the therapists do groups, discharge planning and coordination of services. The technicians also do groups. We don't employ any Psychologists....sorry. The Psychiatrists show up and see the PTs for 10 min, write prescriptions and whatever orders they deem necessary then they leave and the PTs complaint that they don't get to see the physician enough.... that part bugs me. I understand the importance of medication, but it is not enough.

Our adolescent unit can be volatile, has a very high turn around rate....I loved it lol. I seem to have a knack for aggressive patients. I think it is partially because of my military training, I handle aggressive people pretty well if I say so myself. *grin* I spent more time sitting down and talking to those PTs than the physician ever did and I was just a bottom barrel technician. I remember a psychiatrist was physically attacked once and the PT stated it was because they keep doping me up, but they wont sit and talk to me for a few minutes and listen to what I have to say, they don't care about me so I will make them care. I am not saying that was justified...no no no.....but that same aggressive PT was a total sweetheart with me and respectful, why? I talked to them and I was an active listener.

I am not sure which route I will take. It will be Psychologist or Psychiatrist...I think..lol. If I go Psychiatrist, I will not treat patients like medication disposals. It really bothers me

 

[CogNeuroGuy]

Also, my experience has been that psychiatrists make about 4 of 5 times the amount of money compared to a psychologist and that a psychologist makes about twice what a social worker makes. Some days I will regret my decision to become a psychologist and not psychiatrist, but then my wife will point out how I am doing what I love and what I always wanted to do and that helps take the sting out of it when I watch a psychiatrist drive by with their new Ferrari and I get into my 10 year old truck!

I entertained these exact thoughts prior to graduating with my undergraduate degree. I think if you reframe your perspective of the two positions, it could help. For example, while the prestige of being a psychiatrist is nice, your first obligation is to become a competent general physician, then you move into a speciality if you choose to do so. So, let's reframe this: do you enjoy the physics, chemistry, anatomy and pathologies associated with the whole person (mind and body)? If these are topics you are competent within as well as enjoy, then psychiatry could be a good path for you. Secondly, (I tread lightly), if you believe that psychopathology and human behavior is explained by a more biological etiology and prefer pharmacological treatment as a means to alter these behaviors, psychiatry could be a good fit. I will add a caveat, not all psychiatrists take this exact perspective, and as you know, mental health typically accentuates the biopsychosocial paradigm in the evaluation and treatment of human behavior.

Psychologists on the other hand are really geared towards investigating behavior and illness from many theoretical standpoints and use psychometrics as a predominate tool to objectively measure behavioral tendencies. To account from my own experience as well as the people I work with and study under, much of their job is psychometric evaluations, it is often the most money maker in our field (you can easily charge $2-3K per neuropsych. battery). To address your interests in helping people and the therapy involved, I particularly advocate with you. As AcronymAllergy had mentioned, it seems like psychology is shunning people away from the field simply because they have a heavier emphasis in the therapy component of the job description. We as psychologists (future psychologists) are more equipped to evaluate therapy options, why shouldn't we be the ones being "first responders" to the need of a patient? I think you should look into counseling psychology programs as well, as they offer a good deal and a broad range of theoretical platforms and therapeutic approaches to treat varying types of behavior.

In terms of salary, psychiatry obviously has the upper hand, however, I would not use that as the sole criteria, especially with our economy. With more mid-level practitioners coming into play, psychiatry itself is taking a hit, much like how mid-level practitioners (LCSW, LPC, etc.) are taking on a chunk of what psychologists used to do more often. Also, with an aging population, there will be a huge need for mental health care providers in general. Psychologists are expected to grow 12%, general physicians are expected to grow at 18% (note: this is not specific to psychiatry alone, so there is considerable variance at both ends). Other variables that we can't simply account for include the current state of healthcare, projected state of healthcare as well as any unforeseen changes yet to be considered for national healthcare. I would also recommend looking into psychiatric nurse practitioner route, it would cut down the time considerably to achieve the occupational aspirations of a psychiatrist, it would exclude you needing physics or organic chemistry. Some schools (like UT Austin, Vanderbilt University) provide an accelerated option for those without a BSN and have another undergraduate degree in a non-nursing field as long as you complete the pre-nursing requirements and GRE. The estimated salary of a psychiatric nurse-pract. ranges $80-150K (depending on state and geographic concentric areas).

I hope this helps, trust me, I empathize with you greatly as I still toss back and forth the idea of alternative pathways to work as a professional in mental health.

 

[smalltownpsych]

Great in-depth analysis CogNeuroGuy! I'm curious how far along in your career you are and I think it might help the OP a bit to toss out some of your potential plans. I also just want to throw out there that psychologists rock!

 

[smalltownpsych]

lol smalltown. I would never get a Ferrari, I would prefer an economic car that doesn't drain my account with gas ^^ I did research on the money aspect....you are right....I am someone that likes to live slightly below my means and aggressively save money. I would rather have thousands saved and a couple hundred in checking than the other way around. My husband err ummm...I don't know what to call him since we are separated but not legally divorced yet.......well, this should make sense to you...he is bipolar...I am sure you know how money does in the hands of a person in a manic state lol. ANYWAYS.

At my facility the therapists do groups, discharge planning and coordination of services. The technicians also do groups. We don't employ any Psychologists....sorry. The Psychiatrists show up and see the PTs for 10 min, write prescriptions and whatever orders they deem necessary then they leave and the PTs complaint that they don't get to see the physician enough.... that part bugs me. I understand the importance of medication, but it is not enough.

Our adolescent unit can be volatile, has a very high turn around rate....I loved it lol. I seem to have a knack for aggressive patients. I think it is partially because of my military training, I handle aggressive people pretty well if I say so myself. *grin* I spent more time sitting down and talking to those PTs than the physician ever did and I was just a bottom barrel technician. I remember a psychiatrist was physically attacked once and the PT stated it was because they keep doping me up, but they wont sit and talk to me for a few minutes and listen to what I have to say, they don't care about me so I will make them care. I am not saying that was justified...no no no.....but that same aggressive PT was a total sweetheart with me and respectful, why? I talked to them and I was an active listener.

I am not sure which route I will take. It will be Psychologist or Psychiatrist...I think..lol. If I go Psychiatrist, I will not treat patients like medication disposals. It really bothers me

My first inpatient experience was on an adolescent unit and we used psychologists, practicum students, and interns to provide both treatment and assessment. I wasn't sure which direction to go earlier in my career either but I am really glad that I made the choice to become a psychologist. Could I have become a physician? Maybe, at one time in my life that's what I thought I wanted. I am finding that as a psychologist, I get to work with the primary care docs and other medical providers very closely and collaboratively. As a psychologist, I spend my time delving into the latest treatments and conceptualizations for mental illness and the interpersonal factors that go into it. I am constantly developing testable hypotheses about human behavior and critically applying research supported interventions with an understanding of the limitations as well as the strengths of the research. The critical thinking skills that are developed in conducting research, which is part of our skill set, makes for the best practitioners on multiple levels. Basically, when you are delving into the often murky interpersonal world of providing psychotherapy, it is my opinion and that of the majority of psychologists, that having firm grounding in science is essential.

 

[CogNeuroGuy]

Great in-depth analysis CogNeuroGuy! I'm curious how far along in your career you are and I think it might help the OP a bit to toss out some of your potential plans. I also just want to throw out there that psychologists rock!

I am a second year master's student, so theoretically, I would still have 4-6 years (depending on school) left to become a licensed psychologist. My end goal is clinical neuropsychology, so tack on 2 years of post-doc at a minimum. I will be 33-34 by the time I could start practicing independently. I agree, limiting the options down systematically will be the best for the OP. What has made me generally push away more medically-oriented routes of practicing behavioral health is the fact that I have no desire to learn chemistry and physics. My undergrad really accented the social and psychological aspects of behavior and I knew I needed a strong biology component to my background which is why I elected to go down the cognitive neuroscience route for my master's. I like the physics, neurobiology and chemistry in context to the CNS/PNS. In regards to the OP, if you can find out the "likes/dislikes" about going the medical route vs. psychologist route (encompassing mid-level providers as well), I think you will start to paint a better picture. I keep telling myself, "what do I see myself enjoying every day, something that whether I am on or off the clock, it doesn't seem like work." There are parts to psychology that I probably won't enjoy as much as others, but if I can enjoy 90-95% of what I am doing in my profession, I will work hard for it, I will be loyal to the cause and hopefully as a residual effect, money will increase in part due to my competence in the field. Again, that is a subjective way to interpret the situation and is my opinion. I struggled as a career switcher. I went through more depression, heartache and resentment transitioning from my prior career before I started picking up the pieces to re-focus my efforts and to build what I have built for myself today.

Hope this helps 🙂

 

[sameas]

Psychology is such a broad field, with many degree options. I vacillated between clinical and research psychology and ended up going for an academic Ph.D. That was a watershed for me, as I turned down a clinical Ph.D. acceptance. I had shut the door on clinical work and it turned out to be the best decision I ever made (for me). I ended up falling into grant writing and gain great satisfaction from securing funding for behavioral health programs and research. (My path is actually more circuitous, but I don't want to bore you with my life story).

What matters most is your substantive interests. For me, I enjoy working in extremely high need and underserved groups such as people with serious mental illness and HIV/AIDS. The work is highly interdisciplinary with many degrees represented--LCSW, MPH, Ph.D., LPC, MD, NP, RN, CAC, etc. There are certainly MDs and NPs involved in the work, but the field is like a pyramid. There is much more work (albeit lower paying) for medical case managers than for doctors/nurse practitioners. There are also many researchers with an array of degrees from MS to MD-Ph.D. It's staggering to think of how many options are out there.

Having a specific degree is mandatory for many jobs, but unfortunately there is no one-degree-fits-all. That's why it's critical to find the area you think you want to specialize in first. Try to identify your passions--or even better--immerse yourself in a number of shadowing and volunteer experiences. Personally, I don't see the need to foreclose on your options, but you need hands-on experience to know what is your true passion. You should get out there and volunteer/shadow as much as you can--it will look good on your application and also will give you a direction.

 

[LupaCupcake]

wow....thank you.... this post is making me think and truly analyze what do I WANT and where will I flourish. No I am not enthused over physics and chemistry, I see them as a necessity for psychiatrist that I would have to endure although I absolutely loved biology in my undergrad and that is why it became my minor. Neurobiology, the biology of psychology etc. were some of my favorite courses that truly got me excited and I would run to my husband with a big grin explaining something new and exciting I had just studied and he had a look across his face that told me , "I am listening, but I do not understand". Yes money is a factor because raising a child is expensive , of course a route with better pay entices the mind of a single mother that wants to provide the world to her only child. I have some research to do 🙂

 

[smalltownpsych]

Good luck with your decision making process. One way that I have made some of my decisions is by which door opened for me. In other words, you could apply to both psychology doctoral programs and medical school and see which one happens. Another piece of advice that helped me along the way is to always aim as high as you can, if you don't make it then you can always fall back to plan B. Too many people limit themselves.
😎

 

[edieb]

This article, in The National Psychologist, is a good, informative article to read regarding the future of clinical psychology. http://nationalpsychologist.com/2014/05/does-psychology-have-a-viable-future/102507.html I think you are seeing some of what the article points out in your workplace (Master's level clinicians doing the work PhDs/PsyDs used to do, no psychological testing being done, etc). When seeking advice, always try to make sure you're receiving it from people already in the field (licensed as psychologists) asI am seeing many post on here from students that mirror what I thought when I was in my PhD program but come nowhere close to day-to-day realities of the field

 

[CogNeuroGuy]

This article, in The National Psychologist, is a good, informative article to read regarding the future of clinical psychology. http://nationalpsychologist.com/2014/05/does-psychology-have-a-viable-future/102507.html I think you are seeing some of what the article points out in your workplace (Master's level clinicians doing the work PhDs/PsyDs used to do, no psychological testing being done, etc). When seeking advice, always try to make sure you're receiving it from people already in the field (licensed as psychologists) asI am seeing many post on here from students that mirror what I thought when I was in my PhD program but come nowhere close to day-to-day realities of the field

I suppose that is one way you could look at it, however, I would much prefer to hear from a wide variety of perspectives, those in school, graduated, etc. Especially considering she is a unique person (non-traditional), I think the more perspectives that can help her will be helpful. Again, we are just offering opinions from a singular perspective. Considering that there are a handful of people that typically respond to the usual posters on here, it's not exactly the most diverse selection of perspective one could hope to discern from. Please note, I am in no way shape or form knocking the perspectives of those who are regular responders, especially since majority of them are professionally practicing, however they are just a handful.

To add a caveat, sifting through a lot of previous topics on this forum typically yields the same posters (somewhere between 5-10 usuals). The field and professional perspectives are much more diverse, especially off the internet forum. I think it would be only fitting to integrate this diversity here on this board, otherwise you get lurkers, reluctant posters, reluctant return "customers."

P.S. that is a very good article you have provided and something that the OP should consider in her culminating decision she will ultimately need to make. 🙂