Clinical Psychology or Psychiatry?

[HarmlessGhost]

Hello!

Currently, I am an undergraduate student on a pre-med path. I am majoring in psychology and neuroscience. For me, intelligence is not a problem. I don't mean to come across as egotistical, but I am extremely smart. I have never failed a class (or an exam). The last time I got a B on a test was in high school during a family crisis. My favorite courses in high school were math (calculus and algebra mostly, since my precalculus teacher was awful), science (chemistry, biology, physical science), and psychology. I also love literature and theatre, so I consider myself to be pretty well rounded.

Money is also a non-issue. I mean this in the debt sense and the income sense. While I would like to have as little debt as possible, I don't concern myself much with money as long as I am stable and happy. I keep a similar philosophy in regard to income. Time is a bit of an issue, but, from what I have seen, the time difference between clinical psychology and psychiatry is not extremely bothersome (for me, at least).

My main concern is the focus of the two career paths. Ultimately, my goal is to help people, specifically those with mental illness, feel better. This goal stems from a family history of suicide, abuse, and other mental illness, and the failure of the healthcare system to help most people in my family (I am in no way implying that all psychiatrists are bad, just that the ones in my area are less than desirable). I want to remedy that problem, whether it is by revolutionizing the system or simply by helping out one person at a time.

I am extremely passionate about psychology. I adore it, and I have loved every psychology course since the start of college. Admittedly, this is a low number since I am only in my second semester. Due to the number of AP classes I took in high school, I am already a junior. I also love the science courses I have taken. I love anatomy & physiology and, oddly, organic chemistry. While I have yet to take it, biochemistry also sounds fun.

In the future, I can honestly see myself doing research in psychology, being a therapist, or practicing as a psychiatrist. While, the mind is my favorite thing to study, other areas of medicine are also intriguing. My main concerns are who I would be treating and the limits of my career choice. I would want to mainly treat severely depressed, suicidal, extremely anxious, and/or schizophrenic people (basically, I want to focus on the seriously mentally ill). Which career would be best suited for this, clinical psychology or psychiatry? By limits of my career, I mean things such as psychological testing, prescribing medication (which I know is limited to psychiatrists in most states), and talk therapy. I would want to be able to provide the best care, and I think that medication and therapy would be best in some cases. I also think it would be best for a patient to know and trust just one person, rather than having to worry about accurate communication between both a psychiatrist and a psychologist. I could be wrong in this opinion, of course. Regardless, can a psychiatrist provide therapy, and, if so, are there programs that focus on this? What are some pros and cons of both career choices?

I truly appreciate any input. Thank you!

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[MacDonaldTriad]

Psychiatrists provide therapy and this is about the only over lap with psychology. Other than that, the fields are very different so you should be able to figure out which one appeals to you. Are you interested in medicine or not? That is at the core of this decision. If you are not interested in becoming a doctor, do not go to medical school. That would be a very long road to travel if you were not into it.

 

[SixStringPsych]

If you are really focused on treating the severely mentally ill, psychiatry would be a better field. There are many who specialize in psychosis/schizophrenia, and even do research in the field whether that is in genomics, or clinically in terms of use of different antipsychotics. That being said, there is work being done now in the realm of CBT for psychosis, and though I'm not sure how feasible it is that a psychologist would be doing therapy with a psychotic patient, there are psychiatrists who are doing this work and are able to work it into their practice as we see many of these patients on the inpatient unit. Psychiatrists can also work in crisis units, outpatient, and just about anywhere you can think of. Psychologists can as well, but psychiatrists are often a patient's main point of contact in a lot of these settings because we are the ones who do the initial evaluation of a patient. This is what our training is focused on, learning how to evaluate a patient and interact with them in a way that gives us the most information possible about their situation and making an accurate diagnosis.

However this is just me responding to one aspect of what you said OP. What @MacDonaldTriad said is entirely true as well. Medical school is a long road and even if you could handle it, it is very tiresome and will be 4 years of learning to become a doctor first and working within the medical model of healthcare.

I was in your same position 5 or so years ago, so if you want to chat more, feel free to PM me with any pointed questions.

 

[NickNaylor]

You must want to become a physician if you’re thinking about medical school. Even if you’re “going to go into psychiatry,” you should be very aware of the fact that psychiatry is a minuscule portion of the medical school experience, and you will get very minimal exposure to psychiatry as a medical student. Thus, you will spend most of your time studying things that have very little to no direct relation to psychiatry. You might have 4-6 weeks on a psychiatry clerkship and that will be about it.

Going to medical school with a sole focus on becoming a psychiatrist is likely to leave you unsatisfied and wondering what the hell you’re doing there.

 

[SixStringPsych]

You must want to become a physician if you’re thinking about medical school. Even if you’re “going to go into psychiatry,” you should be very aware of the fact that psychiatry is a minuscule portion of the medical school experience, and you will get very minimal exposure to psychiatry as a medical student. Thus, you will spend most of your time studying things that have very little to no direct relation to psychiatry. You might have 4-6 weeks on a psychiatry clerkship and that will be about it.

Going to medical school with a sole focus on becoming a psychiatrist is likely to leave you unsatisfied and wondering what the hell you’re doing there.

i.e. me for the past 3 years.

But being at the point of starting psychiatry residency in just a few months, I'm so happy I made the decision I made.

 

[HarmlessGhost]

Thanks for the input. I find medicine in general interesting. The only aspects that hold absolutely no interest for me would be obstetrics and gynaecology, and dermatology. If I do end up in medical school, I seriously doubt I would be wondering how the hell I ended up there. I guess ultimately, I just want to be able to help the most people possible, especially the seriously mentally ill. It seems to me that, given my goals, the best route to go would be psychiatry (even if I had to spend extra time learning more therapy beyond what would be provided in medical school). With clinical psychology, I would love to research and write about it, as well as therapy. I guess my main concern though would be getting stuck. If I go into a PhD program for it, then I wouldn't really get much exposure to other fields. With medicine, I would get exposure to plenty of other fields. How much extra difficulty would come with an MD/PhD program be, and is it worth the extra trouble?

I do appreciate the comments. They've been very helpful.

 

[wendigo_]

Hi OP, I was in a similar situation to yours as an undergrad. I was attracted to the clinical psychology perspective, so I took that route and was a psych major. I would recommend getting as much exposure to clinical psych as you possibly can, especially in an inpatient setting (if you're interested in abnormal psych/acute psych as you say). I've worked in an inpatient psych hospital for ~4 years, and I immediately recognized the limitations of a psychologist once I started. As in a lot of fields, psychologists are limited by the respect and authority they hold in an acute setting. I'm starting med school in the fall and intend to go into psych eventually, but this is primarily because as a psychiatrist you have more "tools" in your box per se - you can approach treatment from both a psych and medical perspective. This was just my experience, so in summary I would say get as much in-person experience you can from both sides to come up with your own plan.

Edit: As for an MD/PhD program, others may correct me, but these do not exist for PhD clinical psychology as far as I know. You could do a masters in clinical psych concurrently with your MD program (I looked into this) but many people do a psychotherapy fellowship after residency.

 

[HarmlessGhost]

Yeah, I am aware that there aren't clinical psychology MD/PhD programs. Just in general, though is my main question. If I did that, I would probably end up with something like neuroscience. My main concern with the clinical psychology route would definitely be the limitations. I've never heard of doing a masters program concurrently with an MD program, and that is something I will have to look into. Thank you.

 

[nitemagi]

Don't worry about the PhD. I know it seems enticing, but you'll be much better clinically with longitudinal training in therapy rather than doing a separate degree in it. Seriously. Forget the master's program. Stacking degrees won't make you a better clinician IMO. That comes from ongoing and diversified clinical training, which most additional degree programs won't really be offering.

You can optimize you ability to help and learn by having a dual training track -- one official, one for yourself. Learn what's being taught, and always have an eye for what they're neglecting (and may be unaware of), and pursue that material on your own.

 

[HarmlessGhost]

Don't worry about the PhD. I know it seems enticing, but you'll be much better clinically with longitudinal training in therapy rather than doing a separate degree in it. Seriously. Forget the master's program. Stacking degrees won't make you a better clinician IMO. That comes from ongoing and diversified clinical training, which most additional degree programs won't really be offering.

You can optimize you ability to help and learn by having a dual training track -- one official, one for yourself. Learn what's being taught, and always have an eye for what they're neglecting (and may be unaware of), and pursue that material on your own.

So I don't really need to be as concerned as I am about missing out on learning proper therapy techniques?

 

[nitemagi]

So I don't really need to be as concerned as I am about missing out on learning proper therapy techniques?

You'll need to supplement with ongoing therapy training, seeking out mentors and supervisors and reading and doing workshops. But none of that requires an additional degree outside of your MD, just time and commitment.

 

[HarmlessGhost]

You'll need to supplement with ongoing therapy training, seeking out mentors and supervisors and reading and doing workshops. But none of that requires an additional degree outside of your MD, just time and commitment.

That makes sense. I've always sort of assumed I would bedoing supplemental work outside of my speciality no matter what I go into just to ensure that I am always providing the best care/service possible. Thank you, that is something I will seriously consider.

 

[Attending1985]

Unless you want to start your own private practice do not expect to practice psychotherapy as a psychiatrist. It’s just not possible as employed physician. Sad but true reality. If therapy is what you really want to do you’ll be much more satisfied as a psychologist.

 

[splik]

Unless you want to start your own private practice do not expect to practice psychotherapy as a psychiatrist. It’s just not possible as employed physician. Sad but true reality. If therapy is what you really want to do you’ll be much more satisfied as a psychologist.

This is not entirely true. You could also work at an academic medical center, VA, residential treatment center, or group practice and some college mental health positions. Also for positions where they are quite desperate for someone you may be able to negotiate to do some psychotherapy as part of you job (which my friend did for community mental health). But yes, if you want to have a primarily or exclusively psychotherapy based practice then you would be better off having a solo private practice, which is the way it has always been and I think most psychodynamic psychiatrists would not want to primarily work for anyone because it would limit how they are able to practice. Plus all the best patients will see someone in solo or group private practice. It's a massive red flag if they're coming along to some other setting.

 

[HarmlessGhost]

I've always assumed I would end up with a private practice if I go into medicine, so that does not bother me at all. Again, I do appreciate the input!

 

[deleted343839]

I guess my main concern though would be getting stuck. If I go into a PhD program for it, then I wouldn't really get much exposure to other fields. With medicine, I would get exposure to plenty of other fields.

It depends on your emphasis. As a PhD student I was exposed to applied statistics, health services research, neuroscience, and several other branches of psychology (cognitive, social, developmental). But the PhD is fundamentally a research degree, so the breadth comes from exposure to other scholarly disciplines and methodological training. Clinically, yes, we are only trained in clinical psychology. Even psychologists who are legally able to prescribe medication (limited to a handful of states) are not remotely as well trained to do so as physicians.

My main concerns are who I would be treating and the limits of my career choice. I would want to mainly treat severely depressed, suicidal, extremely anxious, and/or schizophrenic people (basically, I want to focus on the seriously mentally ill).

It sounds like your interests lean more clinical than academic. And given your specific interests, I think you would find psychiatry a more versatile and rewarding field for the populations you want to help.

 

[HarmlessGhost]

It depends on your emphasis. As a PhD student I was exposed to applied statistics, health services research, neuroscience, and several other branches of psychology (cognitive, social, developmental). But the PhD is fundamentally a research degree, so the breadth comes from exposure to other scholarly disciplines and methodological training. Clinically, yes, we are only trained in clinical psychology. Even psychologists who are legally able to prescribe medication (limited to a handful of states) are not remotely as well trained to do so as physicians.



It sounds like your interests lean more clinical than academic. And given your specific interests, I think you would find psychiatry a more versatile and rewarding field for the populations you want to help.

Thank you! It does seem like psychiatry is the best route for me to go. Of course, before I make any final decisions I'll look into the shadowing program at my university and keep comparing the two.

 

[WisNeuro]

This is not entirely true. You could also work at an academic medical center, VA, residential treatment center, or group practice and some college mental health positions. Also for positions where they are quite desperate for someone you may be able to negotiate to do some psychotherapy as part of you job (which my friend did for community mental health). But yes, if you want to have a primarily or exclusively psychotherapy based practice then you would be better off having a solo private practice, which is the way it has always been and I think most psychodynamic psychiatrists would not want to primarily work for anyone because it would limit how they are able to practice. Plus all the best patients will see someone in solo or group private practice. It's a massive red flag if they're coming along to some other setting.

I don't know about the VA route, I'm sure it happens somewhere in the VA, but at the 4 that I worked/trained at in the VA system, there were 0 psychiatrists that also did therapy in the units we interacted with.

 

[clausewitz2]

I don't know about the VA route, I'm sure it happens somewhere in the VA, but at the 4 that I worked/trained at in the VA system, there were 0 psychiatrists that also did therapy in the units we interacted with.

There's a psychiatrist at our VA who runs therapy groups in connection with the suboxone program. That's all I got.

 

[Evidence Based]

Good responses on this thread so far. I was seriously considering this question 6-8 years ago as I was finishing up my undergrad. Two things that tipped the scales for me was the amount of research required for the PhD track and scope of practice. While I liked research, it was not something I anticipated being a huge part of my career. Although many psychologists don't do any research once they graduate, it's a huge part of their training, and was something I was less interested in. Second, psychiatry had more flexibility to do the kind of things I was interested in, which for me were working with severely ill populations, getting a foot in the door with health policy, and maybe doing a little bit of therapy. All the things I liked about psychology I could probably do as a psychiatrist, and the things I couldn't do (ex. psychological testing) are things I was less interested.

When combined for the better job prospects for psychiatry, I was sold. I would also agree with posts above that you have to have some interest in medicine as a whole, or else med school would be a slog. I almost went into primary care (IM or FM), but ultimately came back to psych. If you think you could be happy in >1 field in medicine then I think med school is definitely the right path. If you're 100000% sure you'll be doing psychiatry, make sure to do some thinking that the end goal will be worth it.

 

[WisNeuro]

Good responses on this thread so far. I was seriously considering this question 6-8 years ago as I was finishing up my undergrad. Two things that tipped the scales for me was the amount of research required for the PhD track and scope of practice. While I liked research, it was not something I anticipated being a huge part of my career. Although many psychologists don't do any research once they graduate, it's a huge part of their training, and was something I was less interested in. Second, psychiatry had more flexibility to do the kind of things I was interested in, which for me were working with severely ill populations, getting a foot in the door with health policy, and maybe doing a little bit of therapy. All the things I liked about psychology I could probably do as a psychiatrist, and the things I couldn't do (ex. psychological testing) are things I was less interested.

This is something we debunk quite a bit over on the other forum, although I guess it depends on what people consider "huge" to be. There are a lot of balanced programs PhD out there where the clinical piece is definitely the bulk of what you are doing. Many people are doing a thesis and dissertation and still spending most of their time in clinical pursuits.

 

[Evidence Based]

This is something we debunk quite a bit over on the other forum, although I guess it depends on what people consider "huge" to be. There are a lot of balanced programs PhD out there where the clinical piece is definitely the bulk of what you are doing. Many people are doing a thesis and dissertation and still spending most of their time in clinical pursuits.

Fair, thanks for the clarification! I used to haunt those forums too, although my memories are several years stale.

 

[ziggyhope]

I too had the same decision to make almost a decade ago (I decided to go for the MD as a sophomore in college). For me, it came down to the fact that as a psychiatrist, if I am truly only interested in therapy, there are easy paths to do this (private practice, additional training at institutes, etc.). However, if I went the PhD route and decided I wanted to prescribe medicine, understand my patients' other medical issues, I'd probably need the MD after all. So yea, went for the MD.

 

[Attending1985]

This is not entirely true. You could also work at an academic medical center, VA, residential treatment center, or group practice and some college mental health positions. Also for positions where they are quite desperate for someone you may be able to negotiate to do some psychotherapy as part of you job (which my friend did for community mental health). But yes, if you want to have a primarily or exclusively psychotherapy based practice then you would be better off having a solo private practice, which is the way it has always been and I think most psychodynamic psychiatrists would not want to primarily work for anyone because it would limit how they are able to practice. Plus all the best patients will see someone in solo or group private practice. It's a massive red flag if they're coming along to some other setting.

I want to point out that while it’s possible it’s not easy and requires some additional sacrifice, like taking a ****tier job, less pay ect. Med students should know that going in.

 

[nitemagi]

I want to point out that while it’s possible it’s not easy and requires some additional sacrifice, like taking a ****tier job, less pay ect. Med students should know that going in.

Possibly. With the current and anticipated shortages, I wouldn't say that's necessarily true. Doing therapy isn't easy. But finding work as a psychiatrist and asking for what you want is much easier in our specialty (for now) than it is in most.

Since finishing residency I've had 3 jobs, including my current private practice. The first two were for the county, one as salaried in an urgent care and one as an independent contractor doing street medicine work for the homeless. I have been able to negotiate room and time to do therapy in all of them, with no cut in pay, and where members of the treatment team valued my ability to do therapy and interact with other therapists.

As a private practice psychiatrist, I have a niche of using 7+ therapies, with a versatility that others in the community seek out and refer to. And I make a very very good hourly rate with a full practice in one of the most saturated therapy markets in the country.

So it's not easy, but don't fool yourself that it's impossible or that there's less money in it by design.

 

[Attending1985]

Possibly. With the current and anticipated shortages, I wouldn't say that's necessarily true. Doing therapy isn't easy. But finding work as a psychiatrist and asking for what you want is much easier in our specialty (for now) than it is in most.

Since finishing residency I've had 3 jobs, including my current private practice. The first two were for the county, one as salaried in an urgent care and one as an independent contractor doing street medicine work for the homeless. I have been able to negotiate room and time to do therapy in all of them, with no cut in pay, and where members of the treatment team valued my ability to do therapy and interact with other therapists.

As a private practice psychiatrist, I have a niche of using 7+ therapies, with a versatility that others in the community seek out and refer to. And I make a very very good hourly rate with a full practice in one of the most saturated therapy markets in the country.

So it's not easy, but don't fool yourself that it's impossible or that there's less money in it by design.

I’m happy that this has been your experience. It hasn’t been mine or that of my residency classmates. I think a lot of psychiatrists are dissatisfied with the medication management role and my experience is not uncommon. I did not say it was impossible just that for a lot of other specialties there’s more homogeneity in post residency jobs which takes some stress away. Not the case here.

 

[nitemagi]

I’m happy that this has been your experience. It hasn’t been mine or that of my residency classmates. I think a lot of psychiatrists are dissatisfied with the medication management role and my experience is not uncommon. I did not say it was impossible just that for a lot of other specialties there’s more homogeneity in post residency jobs which takes some stress away. Not the case here.

This is definitely against trend of the last 20+ years. In my hired positions I was not offered this time or room directly. I had to advocate for it, and they gave room for it (sometimes skeptically), and then respect that was earned.

This is how new movements begin. In the situation of a shortage, that only raises our leverage in job negotiations.

 

[ziggyhope]

I’m happy that this has been your experience. It hasn’t been mine or that of my residency classmates. I think a lot of psychiatrists are dissatisfied with the medication management role and my experience is not uncommon. I did not say it was impossible just that for a lot of other specialties there’s more homogeneity in post residency jobs which takes some stress away. Not the case here.

I am also still in residency, but it seems that demand for psychiatrists far exceed supply right now, so if someone is open to relocation, sky is the limit in what they can ask for. "Oh you don't want to give me time for X during my work day? No problem, I'll just go call back the other 5 recruiters and see if the positions they represent are willing to consider it". Unfortunately for me, I will be geographically limited due to family reasons, but I still intend to negotiate for what I want. The ability to just walk away from the table because there are plenty of other options is huge.

 

[SixStringPsych]

This is definitely against trend of the last 20+ years. In my hired positions I was not offered this time or room directly. I had to advocate for it, and they gave room for it (sometimes skeptically), and then respect that was earned.

This is how new movements begin. In the situation of a shortage, that only raises our leverage in job negotiations.

I want to be you when I grow up @nitemagi