Career Path: Clinical Psychology PhD or Med School/Psychiatry?

[aydee14]

Hi all! I'm new to this part of SDN. I typically lurk in the psychology forums. Throughout undergrad and up until a couple months ago, I had been in pursuit of gaining admittance to a Clinical Psych Ph.D. program, hoping to become a clinician and researcher. However, my sister-in-law who recently finished her residency (in an unrelated field) expressed to me that she was always surprised that I wanted to go the psychologist route vs. the psychiatrist route. I told her I wanted to do psychotherapy with my patients, not just med management because I felt that I would not be able to develop a significant relationship with them in 15 minute sessions. She told me that while many psychiatrists do primarily do med management, there are some that do a large amount of psychotherapy, and that it could ultimately be up to me as a psychiatrist. Also, she could see me feeling frustrated as a psychologist by not having control over my patient's medication if their psychiatrist's decisions do not align with what I see in my patients (if that makes sense? I'm having trouble wording it). A psychiatrist's salary is obviously much higher than a clinical psychologist's so that is another tempting factor. Lastly, I would think having the education and training to understand my patients on a biological level and a psychological level would mean I would be better able to fully understand the problems they present with and how to treat them.

So, I'm hoping some of you can answer some of my questions regarding this potential change in career path.
1. I know it is more financially beneficial to do 3 15-minute med management sessions than 1 45/50-minute psychotherapy session, but if I (as a psychiatrist) am primarily doing psychotherapy (and incorporating med management) with my patients, what would my salary look like compared to a psychiatrist doing primarily med management and a psychologist doing psychotherapy? Is it a totally bad idea considering the amount of student loan debt I would be in after med school (a lot) vs. a clinical psych Ph.D. program (very little for a fully funded program with stipend)?
2. How much flexibility do I actually have in determining whether I do primarily psychotherapy or primarily med management? Obviously I would have complete control if it were my own practice, but what other settings would allow me to have this flexibility?
3. Any other concerns that I'm overlooking?

Sorry for such a long post!

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[heyjack70]

You can get an msw and do as much counseling as you want.

 

[smalltownpsych]

Doing full-time psychotherapy is a tough job. I just did 9 sessions today and then spent an hour on the phone with the idiots at my student loan servicer and then got mad at my wife. After a day like today, I really think that I should have gone to med school. Truthfully, there are pro's and con's to both paths. I have been taught and believe that psychotherapy starts the moment someone walks through the door and regardless of whether it is your sole focus such as in my practice or adjunct to medications as in most psychiatrists, it is still essential to have the skills. Medications have meaning and psychological effects as well and a good clinician will take that into account. At the end of the day, I would recommend that you follow your heart. I always wanted to be a psychologist not a psychiatrist and I think deep down it's because I like the way psychologist rolls off the tongue. Nevertheless, I love being a psychologist and being an expert on diagnosis, psychotherapy, research, consultation, self-care, and teaching. It's a cool skill set and I make a good living and enjoy my job most days, I just get a little cranky after a long week. I think I need to go soak in my hottub.

 

[PikminOC]

Doing full-time psychotherapy is a tough job. I just did 9 sessions today and then spent an hour on the phone with the idiots at my student loan servicer and then got mad at my wife. After a day like today, I really think that I should have gone to med school. Truthfully, there are pro's and con's to both paths. I have been taught and believe that psychotherapy starts the moment someone walks through the door and regardless of whether it is your sole focus such as in my practice or adjunct to medications as in most psychiatrists, it is still essential to have the skills. Medications have meaning and psychological effects as well and a good clinician will take that into account. At the end of the day, I would recommend that you follow your heart. I always wanted to be a psychologist not a psychiatrist and I think deep down it's because I like the way psychologist rolls off the tongue. Nevertheless, I love being a psychologist and being an expert on diagnosis, psychotherapy, research, consultation, self-care, and teaching. It's a cool skill set and I make a good living and enjoy my job most days, I just get a little cranky after a long week. I think I need to go soak in my hottub.

Do you have control over your schedule so you don't have so many sessions?

 

[smalltownpsych]

Do you have control over your schedule so you don't have so many sessions?

Yes, but I also get paid based on how much I bill so on a day like today when everyone shows up it's good financially but a bit taxing especially when it's been a busy week. A lot of days I get a few breaks because of no shows or cancels that I can't fill so I tend to schedule more work than I can handle. I have been building up my practice for about a year now so I have weeded through the flaky patients who don't really want therapy for themselves and now my patient load is more solid so I might have to dial it down a bit. I do feel a whole lot better after a long soak and I am not on call right now so this weekend I will do some physical work and not think at all!

 

[nitemagi]

1. Depends on location, cash vs. insurance (you probably need to be cash), your skill level at therapy, and business skills at building a practice.
2. If you take a salaried job, very little (negotiate up front). If you do private practice, you can do whatever you want. Few other settings would allow for this. I suspect you could negotiate some therapy time if taking a job somewhere, but some might frown (maybe).
3. Um, getting into med school. Make sure you can handle the science of the prerequisites, are prepared to study ALL of medicine, and then continue on doing therapy training even after residency.

 

[Shikima]

Yes, but I also get paid based on how much I bill so on a day like today when everyone shows up it's good financially but a bit taxing especially when it's been a busy week. A lot of days I get a few breaks because of no shows or cancels that I can't fill so I tend to schedule more work than I can handle. I have been building up my practice for about a year now so I have weeded through the flaky patients who don't really want therapy for themselves and now my patient load is more solid so I might have to dial it down a bit. I do feel a whole lot better after a long soak and I am not on call right now so this weekend I will do some physical work and not think at all!

Ah the good 'ol 'catch what I eat' model. Nice to have the flexibility but also pushes one to work harder to make ends meet.

 

[PikminOC]

Yes, but I also get paid based on how much I bill so on a day like today when everyone shows up it's good financially but a bit taxing especially when it's been a busy week. A lot of days I get a few breaks because of no shows or cancels that I can't fill so I tend to schedule more work than I can handle. I have been building up my practice for about a year now so I have weeded through the flaky patients who don't really want therapy for themselves and now my patient load is more solid so I might have to dial it down a bit. I do feel a whole lot better after a long soak and I am not on call right now so this weekend I will do some physical work and not think at all!

Are you in private practice?
In hospitals/employed positions they usually do the RVU system which is the same method of compensation...

 

[smalltownpsych]

RVUs at a hospital. It works out well for me, very much like a private practice with a lot of support staff and solid benefits and no administrative headaches. I especially like the education benefit that pays for some nice trips. Will spend a week in cape cod this summer. Definitely looking forward to that.

 

[Sophie]

I agree with nitemagi regarding your questions, although I'd add that the city you're in will also play a big part in how open practices are to allowing you to do therapy. I trained in SF, and almost all of my attendings spent more of their time doing therapy than med appts. Several of my co-residents joined group private practices that allow them to do as much therapy as they like. I think this is largely due to SF having a lot of people able to pay cash who prefer to see one person for both therapy and meds.

If you go the psychologist route you really have to be 100% sure you'll like doing therapy. I thought I did, considered getting a PhD instead of an MD, and chose a residency program that focused on excellent therapy training. Turns out I really don't like it. Since I got my MD that isn't an issue, but it'd be pretty limiting if I'd gone for the PhD.