Do docs look down on Psychs

[Psychotik]

I;ve been working as an assistant psychologist and i'm constantly hearing how consultants and docs looking down on psychologists, also even though psychologists play a role in the healing process it is ultimately the doc that has the final say.

I must admit that this is quite depressing...

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[50960]

I work with physicians every day and have for years, and have never experienced this. In Ca, and most states psychologists have an independent license to practice so MDs do not have the final say unless it is something not psych related, and out of our scope of practice. The exception to this is psychiatry.

 

[sasevan]

I;ve been working as an assistant psychologist and i'm constantly hearing how consultants and docs looking down on psychologists, also even though psychologists play a role in the healing process it is ultimately the doc that has the final say.

I must admit that this is quite depressing...

Unfortunately, there are people who are prejudiced and discriminate against those who they consider inferior due to gender, race, ethnicity, religion, sexual orientation, etc, including academic training or professional practice. I've seen physicians do this against psychologists (and also against psychiatrists) and vice-versa. I've even seen PhD psych do this with PsyD psych and vice-versa.
IMO the best course is to evaluate the individual and not judge her or him because of their group affiliation.
I'm curious, though, as to what "looking down" refers to; care to elaborate?
Peace.🙂

 

[Psychotik]

well often the physicians are referred to 'Psych friendly' if they like psychologists otherwise i get the general impression that they think psychologists aren't 'up to' the medical standard which according to them is better.🙄 I can't say im TOO surprised that some people do this-- i did get a lot of 'Oh? Psych? Really?' at uni too!

 

[50960]

I have worked directly with MD/DOs for years and I can tell you this; if you present yourself as inferior, apologetic, and needy you will be treated as such. If you present yourself in an assertive, confident manner you will be treated as an equal. MD/DOs have no idea what our training entails, but I have seen many psychs doom themselves to inferiority by their own lack of confidence and blame it on medical arrogance.

 

[NeuroPhD]

I have worked directly with MD/DOs for years and I can tell you this; if you present yourself as inferior, apologetic, and needy you will be treated as such. If you present yourself in an assertive, confident manner you will be treated as an equal. MD/DOs have no idea what our training entails, but I have seen many psychs doom themselves to inferiority by their own lack of confidence and blame it on medical arrogance.

Very well said. However, in some clinical settings psychologists are very clearly "beneath" physicians within the hierarchy of professionals. For example, I trained in some sites where psychologists were always addressed by their first name, and all physicians were referred to as "Doctor," including residents. In addition, psychologists were not permitted to park in the "doctor's" lot. The culture of some medical settings just doesn't promote any sense of equality. In many rehab settings, psychologists are viewed as allied health professionals, with similar status to speech pathologists and physical therapists. Just the way it is. Other places I've trained, there is a clear sense of equality.

 

[sasevan]

However, in some clinical settings psychologists are very clearly "beneath" physicians within the hierarchy of professionals. For example, I trained in some sites where psychologists were always addressed by their first name, and all physicians were referred to as "Doctor," including residents. In addition, psychologists were not permitted to park in the "doctor's" lot. The culture of some medical settings just doesn't promote any sense of equality. In many rehab settings, psychologists are viewed as allied health professionals, with similar status to speech pathologists and physical therapists. Just the way it is. Other places I've trained, there is a clear sense of equality.

I agree.
While the med ctr where I was trained has the rep of being very respectful of psychology and where there were in fact many psychiatrists/psychologists, including the Dept Chair, there was some bias against psychology. For example, during my last year of training, one of the psych MD attending had the tendency to always introduce the psychology fellows to the psychiatry residents by using the first name for the former and the title "Doctor"
for the latter. AND, the psychology attendings wouldn't say anything! Even worse, in case conferences the psych PhD/PsyDs would often defer to the psych MD/DOs in issues of non-medical assessment and treatment. Finally, I decided to be assertive and addressed the issues with the chief psychologist and things started to change; e.g. fellows began to be called "Doctor" by the aforementioned MD. But the whole experience made me question if our current model of training (not becoming Doctors until after internship; not being more exposed to medicine in the years prior to internship) does not lend itself to this perception that psychologists are inferior to physicians.
In my experience, this perception often leads some physicians to see psychologists as one more service of "therapists" just like PT, OT, or RT.
Peace.
P.S. I'm curious as to what others in this forum think about making internship post-doctorate.

 

[Pterion]

So far in medical school, I have found both - but it has been specific to the individual. For example, I watched a psych attending pimp his students on differential diagnosis from my SOAP note. I was very surprised by this. As a third year medical student I don't expect attendings to think very much of my "medical expertise". I later found out that this particular psychiatrist was poorly respected and generally considered a dud.

On the other hand, we had a psych consult while I was on ICU. Being short-staffed, they sent a PhD rather than an MD. This PhD was very much respected as an expert. Since the issue did not involve medication, he was definitely the preferred consult. To be fair, my program does not have the strongest training for psychiatrists, so our local opinion is likely also an artifact of the less than top-teir students in the program.

A good psych consult, properly referred and properly executed is worth its weight in gold. See a related thread in the psychiatry forum on the referral issue.

 

[sasevan]

So far in medical school, I have found both - but it has been specific to the individual. For example, I watched a psych attending pimp his students on differential diagnosis from my SOAP note. I was very surprised by this. As a third year medical student I don't expect attendings to think very much of my "medical expertise". I later found out that this particular psychiatrist was poorly respected and generally considered a dud.

On the other hand, we had a psych consult while I was on ICU. Being short-staffed, they sent a PhD rather than an MD. This PhD was very much respected as an expert. Since the issue did not involve medication, he was definitely the preferred consult. To be fair, my program does not have the strongest training for psychiatrists, so our local opinion is likely also an artifact of the less than top-teir students in the program.

A good psych consult, properly referred and properly executed is worth its weight in gold. See a related thread in the psychiatry forum on the referral issue.

Hi Pteiron,
Congrats on being a third year; I'm currently (and finally) applying.
Have you reconsidered not going into psychiatry? I'm still committed to it.

Like you, I believe it comes down to the individual: in my med ctr there were examples of psychiatrists and other physicians who weren't very respectful of what psychology brought to healthcare and others (a nephrologist and cardiologist come to mind) that very much recognized and supported it.

Congrats again. 👍

 

[Pterion]

Thanks for the well wishes. Step I went very well, which opens up a lot of doors regarding residency options. I won't say never to psychiatry, but it would be near the bottom of the list of possibles for me.

The respect (or lack thereof) frequently has a lot to do with the lack of understanding regarding training. Since most grad school programs lack the residency experience of doctors, the training is assumed to be less intense. Before the flamethrowers come out, let me be clear: I am reporting, not opining.

My personal experiences include once being introduced to a team of interns and residents as "a medical student who already has a doctorate, so he's smarter than we are". I have also been introduced as "a guy from psych" to a chorus of groans and chuckles. Totally depends on the context. I have tried to be a good representative of our profession and have yet to be directly put down once I had a chance to show what psychology can contribute.

My opinion is this: believe this lack of respect is most common among the fields who have the highest expectations for immediate results placed on them. For example, trauma surgeons have no time or interest in your upbringing. Their job is to fit all your pieces back together and move to the next one. By definition, this type of career will not attract those who wish to consider deeply contextual ramifications. So you are more likely to find these folk impatient with what they perceive as unnecessary mentation. You will also find them to have that same opinion of oncology medicine, for example. Psych and oncology both largely deal with amorphous, continually evolving problems that are complex and chronic. Irony: the complex thinkers are frustrated with what they see as primitive, concrete mentation on the part of trauma surgeons. But each style serves its purpose. Completely different mindsets.

Clearly, healthcare needs both types of specialists. One is not inherently superior to the other.

 

[NeuroPhD]

I have tried to be a good representative of our profession and have yet to be directly put down once I had a chance to show what psychology can contribute.

That's a big part of it. One good psychologist can have a powerful impact on the profession's reputation. Unfortunately, psychology does not yet have the quality control/standardization of training that medicine has. I've worked with way too many psychologists who did not reflect well on the profession.

I think another issue is that medicine has been the only medical authority until very recently. Suddenly there are doctoral level professions coming out of all kinds of fields, and turf wars are popping up everywhere. The only environment I've felt intentionally disrespected was psychiatry, and it really seemed to be related to the psychiatrist feeling that his expertise was being challenged. I've become much better at playing professional politics, but it still happens on occasion.

Arrogance is also much more accepted in medicine than in other professions. There are arrogant people in every field, but physicians can often express it without the professional ramifications that exist elsewhere. I think a psychologist who sees him/herself as above another professional would be less likely to show it.

 

[PsiKo]

I've worked with way too many psychologists who did not reflect well on the profession.

I know what you mean. Some even moderate message boards.

 

[Jack223]

I'm trying to decide b/w med school and psych and I have to say that the idea of getting a phd/psyd in clinical psych only to have to put up with crap like this is discouraging. If you go into forensic psych or have your own private practice you wouldn't have to deal w/ stuff like this right? Is there any other way to avoid it or other specialties where you avoid it more? And what if you go to a program affiliated w/ a med school, would the attitudes be worse there or does it just depend on the program?

 

[50960]

Psiko you are not the first undergrad newbie to come here with misguided info posted with complete assurance, that I have corrected (or others for me), and have taken it personally. Those who can recover, admit they have alot to learn, do very well here and learn alot from some great professionals and/or students on this site. Those who get peaved and all vindictive, do not. You are welcome here, but be ready to be corrected when you are wrong, or have the ability to show you are not.

peace

 

[Pterion]

I'm trying to decide b/w med school and psych and I have to say that the idea of getting a phd/psyd in clinical psych only to have to put up with crap like this is discouraging. If you go into forensic psych or have your own private practice you wouldn't have to deal w/ stuff like this right? Is there any other way to avoid it or other specialties where you avoid it more? And what if you go to a program affiliated w/ a med school, would the attitudes be worse there or does it just depend on the program?

This is a much bigger problem within psychology than anywhere else. Choose your career based on your passion/interests/knowledge/skills/abilities. Those that will hold contempt for you based solely on your membership to particular discipline can:
1. Likely never be schooled in their attributional error
2. Bear no power to determine the success or happiness you experience in your career.

Face it, no matter what you do, SOMEONE will look down on you for something. Do your job, do it well, and the rest can go spit. Yes, some physicians look down on psychologists. Yes, some PhDs look down on PsyDs. Nature of the beast. You will develop your own prejudices as your life unfolds. Private practice or medical school affiliation of your program will not innoculate you from human imperfection. Accept it as a hazard of healthcare. Excel and you will do well. It really is as simple as that.

 

[PsychevalIII]

Once again, I find myself agreeing with Psisci. I am becoming exhausted with the field of psychology becoming overrun by brilliant folks with low self esteem. Why would we care about what another profession thinks of us? Do your job and do it well, period.

It's strange, many of my physician colleagues in primary care complain about their patients with no health insurance driving nicer vehicles than they drive. However, I recently had a patient say to me, "I guess if I made $150 an hour I would work on Saturdays to."

 

[NeuroPhD]

Once again, I find myself agreeing with Psisci. I am becoming exhausted with the field of psychology becoming overrun by brilliant folks with low self esteem. Why would we care about what another profession thinks of us? Do your job and do it well, period.

I don't see it that way. I think it is the job of every psychologist to advocate for the profession. Just doing your job well is not enough. If the profession is not respected, other clinicians will not identify your solid work with the field as a whole. When institutions develop policy, decisions are based on the value of the field, not available individuals. I know of two rehabilitation hospitals that eliminated psychology completely. It didn't matter that some of the clinicians were well liked/respected. The field hadn't proven its worth to those hospitals. We are a referral based profession. The way physicians see us will always be an important part of our success or failure.

 

[PsychevalIII]

[QUOTE=NeuroPhD;4137876]I don't see it that way. I think it is the job of every psychologist to advocate for the profession. Just doing your job well is not enough. If the profession is not respected, other clinicians will not identify your solid work with the field as a whole. When institutions develop policy, decisions are based on the value of the field, not available individuals. I know of two rehabilitation hospitals that eliminated psychology completely. It didn't matter that some of the clinicians were well liked/respected. The field hadn't proven its worth to those hospitals. We are a referral based profession. The way physicians see us will always be an important part of our success or failure.[/QUOTE]

I have found doing what you do well tends to lend itself to respect from other professions. However, my point is, I see increasing problems with how psychologists are socialized in training programs. This socialization process lends itself to a group of highly talented, intelligent professionals who second guess themselves. I appreciate your conviction, but I would never work in an environment past fellowship that treated a doctoral level psychologist with the type of disrespect you describe (calling a psychologist by their first name, doctors parking lot for MD/DO's only, or a facility eliminating psychology because the value was not noticed). It seems that a part of a healthy professional identity is to recognize when an environment is toxic, and move on. It seems that an important role in our advocacy is to become independent, not dependent.

 

[soaringheights]

I work in a the psyhciatry dept of a government hospital here, and my interaction with the med docs is pretty pleasant. They do not have a condescending attitude towards psychologists, and in fact have even told me that they look forward to learning a lot from psychologists, the same way I look forward to learning from them. I think a big reason for this behaviour is because I consider myself to be their equal, so do not have a deferential attitude towards them. It depends a lot on the way you conduct yourself in front of the medical fraternity, and if you feel yourself to be an outsider, you will most probably be thought of as one too! Of course, there are always some who would look down upon psychologists, but what do I care about such people! Its their attitude, let them have it!!!! I think the best way such an attitude can be changed is by delivery of quality service. And lets face it, beyond a point, it doesn't even matter.

 

[Psychotik]

I guess it does depend on the individual as well as society/ government etc. When psychologists are being paid so much less than docs isn't it kinda saying that what we do is of less value anyway? And of course theres the whole thing where psychologists seem to be just part of the system, it is the docs job to refer and have the final say about what should happen to the client.

I would actually like for psychologists to have more power in the NHS. Esp since the amount of training we have to go through to get here in the first place.

Also i agree with whoever said that trauma surgeons would be the type to look down on psychs. They are looking at two completely different thing. A 'cure' for a surgeon and a psychologist would come from two completely different models. Perhaps we should look down on them!

 

[PsiKo]

If you go about getting your training in the proper fashion, you should have minimal to no debt (unlike your physician counterparts). If you join the growing masses in the professional school world, you may have a problem.

Can you elaborate on this point?

 

[NeuroPhD]

There are two ways to become a clinical psychologist, Boulder and Vail models. The Vail model (PsyD) is heavily dominated by businesses that charge med school-like prices for tuition, hence students have med-school like debt coming out of training without the potential for high six figure incomes (like some medical specialties) and no guarantee of a good income (though it is possible). This, in my opinion, is the wrong way to go about getting into clinical psychology. It also floods clinical psych with lesser professionals and contributes to disrespect from other health professionals because the requirements for admission to these programs are minimal.

Every psychologist I've talked to about the above issue is in agreement. The professional school industry can't be good for the field, but I've never heard anything from APA about increasing quality control. There are some great Vail model programs, but any field that allows programs that train its "doctors" in rental space in a business park is likely to have trouble with credibility.

 

[Jack223]

So in a hospital environment are there times when you can't do treatment on a patient that you think is necessary if a MD decides it's not? Also can someone tell me if you run into this "MDs looking down on psychologists" attitude in forensic psych or neuropsych (two fields i'm interested in)??? I'm not gonna base my decision whether to go into clin psych or med school based soley on MDs attitude toward psychologists, but i'm gonna take it into consideration.

 

[Pterion]

So my attending assigned me to present a talk on the contributions that psychologists can make to doctors practicing internal medicine. (Note that I am on my Internal Medicine rotation, so they don't care what psychology can do for surgery) Good news, it was either that or identify the actual risk reduction and NNT from the original carvedilol study. As I stated earlier, I think that any prejudice an MD has toward a doctorally-trained psychologist is simply misinformation regarding the latter's training.

Anyway, the residents and the attending were quite impressed, as they were unaware of the evidence-based aspects of the field. On the contrary, they were well-aware of the mealy-mouthed apologists who spoke to patients in child-like voices and never offered any concrete guidance into the management of medical problems with psychological components or sequelae. I briefly discussed gross screening tools (EG the BDI, SCL family and even spent some time on the basic scales of the MMPI), evidenced-based psychotherapies such as CBT (despite its conceptual flaws) and interpersonal. I finished by clarifying the modern understanding from a bioneurological perspective of common Freudian constructs such as transference and repression.

As a result, my attending is in the process of collecting a referral list of psychologists to consult for mental health issues. And even though a lonely medical student, I am now asked daily my opinion as a psychologist on patients' issues on the medicine ward.

Yes, this is a single case report and an isolated incident. But it demonstrates that the two fields CAN work together, an respect each other's areas of competence.

 

[Sanman]

As far as respect, I honestly believe the words that were shared with my class from a health psychologist and practicum supervisor in my program. He said that physicians will respect any professional that can help them do their job more effectively. By working with physicians to figure out how to best deal with non-compliant patients, he has made their lives easier and gained their respect. I have never met a doctor or any other professional not respect another that has aided them in their work. Being competent and making your skills useful will gain you respect, those who don't respect another professional a generally mot familiar with them or have simply had a bad experience.

 

[PsychevalIII]

Primary care physicians end up caring for mentally ill patients by prescribing psychotropic meds. Most primary care docs I work with are not crazy about working with the mentally ill. However, they end up prescribing psychotropics because of psychiatry’s failure in meeting the needs in their area. Another way to help primary care physicians would be to push prescriptive authority for psychologists forward. 🙂

 

[50960]

Then why are you posting in our forum? Oron-me.

 

[Therapist4Chnge]

.....physicians will respect any professional that can help them do their job more effectively. By working with physicians to figure out how to best deal with non-compliant patients, he has made their lives easier and gained their respect.

I used the exact rationale when I was in the business world. I was younger than the rest of my colleagues, but I earned their respect by my thoroughness and results. I not only proved my ability, but became an information expert in the field, so I had people with far more experience and pull requesting I manage their projects, etc. If you become that type of resource for your referring physicians, they will go out of their way to help you out. You have to remember that if you do good work, they look good bc they were able to refer to a competent professional.

-p

 

[BleepTastic]

As a result, my attending is in the process of collecting a referral list of psychologists to consult for mental health issues. And even though a lonely medical student, I am now asked daily my opinion as a psychologist on patients' issues on the medicine ward.

So you're a Psychologist who is in Medical school? Why did you decide to go to Med school after training in Psychology?
I'm here trying to figure out if the PHDPsych or the MD Psych is the best route for me.

 

[Moola]

I'm a fourth year medical student, and I'm gonna give you the SURGEON'S take on this.

I must say that I had a really $hitty experience in my psychiatry rotation. I love people and came into the rotation with a strong sense of empathy and care for people in the wards who had a tough luck at the races and were branded with PSYCHIATRIC ILLNESS. I thought that psychiatrists would be there for them to talk things out and be a friend to these people. I would stay until 6 or 7PM on my psych rotation to talk to my patients and understand them, while my attending would bolt at 3pm. The only time they spent with these patients was 3-4 minutes during morning rounds to make sure they haven't slit their wrists. On outpatient services, NPs would see the patients with the occasional visit by the psychiatrists. I found them to be pillpushers and writing Haldol/Ativan orders to sedate the patients until they could get out of the hospital by 3PM. They frequently laughed at the patients and seemed very callous and judgemental of them. I saw no compassion or understanding at all. I'm going into ENT and then Plastic Surgery and I found that even the surgeons are FAR more understanding of their patients than psychiatrists.

Now, on to the PSYCHOLOGISTS...
I think they are much better than the psychiatrists. While psychiatrists are attendign cushy drug lectures and pushing pills and sizing up patients. I found that our consult psychologist was really there for the patietns and actually hearing them out. I think that the ability to prescribe has really f#$@ed up the minds of the psychiatrists that they think a pill is the quick fix. The most I learned about the human mind was from a PSYCHOLOGIST not a psychiatrist.

As a future Plastic/Reconstructive Surgeon, I am going to frequently consult a PSYCHOLOGIST to help me better select and screen my patients and understand them as well. I admit that sometimes it is hard to spend enough time to fully understand patients with OR responsibilities and followups and for this reason, as a surgeon, we surprisingly rely heavily on psychologists. Yes, in the end I became very bitter towards psychiatrists and their insistence in solving everything with a pill and a swig of Haldol/Ativan. This really made me appreciate psychologists perspecive on the other hand in their focus on talking to the patients rather than doping them up.

 

[Pterion]

So you're a Psychologist who is in Medical school? Why did you decide to go to Med school after training in Psychology?
I'm here trying to figure out if the PHDPsych or the MD Psych is the best route for me.

I am a doctoral clinical psychologist, fully licensed (inactive) and am now a third year medical student.

PM'ed you on the second question.

I suggest that you spend a lot of time researching this question. At your level there is simply no way you can trust a school advisor or a few friends (like some of us did....) Talk to AT LEAST five different docs in each field. Spend time with them all seeing what they do, how they do it. Ask direct questions about income, quality of life, job satisfaction, regrets, funding. Look at academics and private practice.

Ignore salary surveys on the internet. There are no truly independent groups who report this. They are either recruiter groups (for physicians) or thinly veiled PAC's. Ask the practitioners. Average all these data to give you a ballpark.

This sounds involved, and it is. But this is a serious question you're asking. Be viciously honest with yourself once you have done this. If it doesn't feel right, back off. If it opens more questions - research more. This is absolutely worth your time at this point in your career. Either way, you will be happy you put in the time.

 

[Psychotik]

whoops was meant to be a pm

 

[Pterion]

hi i read your thread on the clin psych forum. I'm a psychologist who is interested in clinical aspects. Am thinking of going into medschool too. I was wondering how you made your decision to do so and any general advice?

thanks!

This was a hard decision that was made with a LOT of research. I had a career, a "decent" income for a psychologist and a lot of risk related to the move. My particular situation was unusual (not special) and so there is little that can be extrapolated. I was dissatisfied with the job, the income, the opportunities, my colleagues of questionable scientific background, etc. This is not an indictment of psychology, but rather my experience in it. Good jobs and good professional lives can be had in this profession.

My advice is as I said to BleepTastic. Research the living Hades out of this question. Medicine is not a path to an easy life or huge income. They can be had, to be sure. But you can do it in psychology, too. I am very happy that I made the switch. It was the right move for me. I do get a lot of use out of my psychology training. In fact, I just received a commendation letter in my permanent file for exceptional patient care for my "level of training". You can PM if you want about why you think you want such a significant professional shift.

My next rotation is psychiatry. Should be very interesting at a number of levels....

Psisci - let me know if this subtopic is hijacking the thread and I will desist forthwith.

 

[Psychotik]

I'm a fourth year medical student, and I'm gonna give you the SURGEON'S take on this.

I must say that I had a really $hitty experience in my psychiatry rotation. I love people and came into the rotation with a strong sense of empathy and care for people in the wards who had a tough luck at the races and were branded with PSYCHIATRIC ILLNESS. I thought that psychiatrists would be there for them to talk things out and be a friend to these people. I would stay until 6 or 7PM on my psych rotation to talk to my patients and understand them, while my attending would bolt at 3pm. The only time they spent with these patients was 3-4 minutes during morning rounds to make sure they haven't slit their wrists. On outpatient services, NPs would see the patients with the occasional visit by the psychiatrists. I found them to be pillpushers and writing Haldol/Ativan orders to sedate the patients until they could get out of the hospital by 3PM. They frequently laughed at the patients and seemed very callous and judgemental of them. I saw no compassion or understanding at all. I'm going into ENT and then Plastic Surgery and I found that even the surgeons are FAR more understanding of their patients than psychiatrists.

Now, on to the PSYCHOLOGISTS...
I think they are much better than the psychiatrists. While psychiatrists are attendign cushy drug lectures and pushing pills and sizing up patients. I found that our consult psychologist was really there for the patietns and actually hearing them out. I think that the ability to prescribe has really f#$@ed up the minds of the psychiatrists that they think a pill is the quick fix. The most I learned about the human mind was from a PSYCHOLOGIST not a psychiatrist.

As a future Plastic/Reconstructive Surgeon, I am going to frequently consult a PSYCHOLOGIST to help me better select and screen my patients and understand them as well. I admit that sometimes it is hard to spend enough time to fully understand patients with OR responsibilities and followups and for this reason, as a surgeon, we surprisingly rely heavily on psychologists. Yes, in the end I became very bitter towards psychiatrists and their insistence in solving everything with a pill and a swig of Haldol/Ativan. This really made me appreciate psychologists perspecive on the other hand in their focus on talking to the patients rather than doping them up.

oh wow, really?
I hope that isn't the general attitude of all psychiatrists... And if it is its really disheartening. Having worked with quite a few psychologists over the past month I can truly say that they are very patient/recovery focused and tend to take patient care very seriously.

 

[anon-y-mouse]

all physicians were referred to as "Doctor," including residents.

Actually, anyone with an MD is referred to as "Doctor", including interns and residents. And technically, after USMLE step 3 and an intern year, MD's can hang up their sign to practice any field of medicine they wish (although insurance companies likely won't pay you unless you've done a residency in that particular field).

Of course this has nothing to do with your experience and the debate, I thought I would make that clarification.

 

[QPublic]

I notice a lot of people (including psychologists) refererring to the 'docs' (ie, physicians). Conversationally, I use the term physicians. As psychologists, we are doctors too. I recently started a new job, switching hospitals, and I notice this more. Maybe it's just me, but it seems like one small way that psychologists contribute to the status quo. What do you people think?
I agree with the comment that was made earlier about rehab settings tending to treat psychologists as another therapy discipline a la OT, PT, ST. That said, the physicians respected my knowledge/expertise as a doctoral psychologist (as well as the 'doctor' title that accompanies it). It took a bit of educating for other staff though I think it was largely successful.
I was surprised to receive a letter my job offer from HR addressing me by first name. Personally, I find that rude. The hospital privileges packet addressed me as Dr. So-and-So (which is interesting, becuase my last name is QPublic, not So-and-so!). Like several others have posted already, I am often embarrassed by those psychologists who come across as meek and deferent to the 'docs'. True, hospitals follow a medical hierarchy dominated by MDs/DOs/RNs (yes, they have quite a chunk of power), but we need to talk the talk and walk the walk to be relevant players. And of course, know our stuff and practice effectively.

I guess it does depend on the individual as well as society/ government etc. When psychologists are being paid so much less than docs isn't it kinda saying that what we do is of less value anyway? And of course theres the whole thing where psychologists seem to be just part of the system, it is the docs job to refer and have the final say about what should happen to the client.

I would actually like for psychologists to have more power in the NHS. Esp since the amount of training we have to go through to get here in the first place.

Also i agree with whoever said that trauma surgeons would be the type to look down on psychs. They are looking at two completely different thing. A 'cure' for a surgeon and a psychologist would come from two completely different models. Perhaps we should look down on them!

 

[Therapist4Chnge]

QPublic.....I completely agree.

If you don't have the respect for your status, then it is not realistic to expect others to give it to you.

-t

 

[50960]

Qpublic, I agree with you 100%, thanks for chiming in. I have written about this deferential way alot of psychologists have towards physicians not even knowledgeable in their area of specialty (IE family docs etc.). I have named this "PhD syndrome". Perhaps I should write an artilce about this??? LOL..

 

[Therapist4Chnge]

Qpublic, I agree with you 100%, thanks for chiming in. I have written about this deferential way alot of psychologists have towards physicians not even knowledgeable in their area of specialty (IE family docs etc.). I have named this "PhD syndrome". Perhaps I should write an artilce about this??? LOL..

You should seriously do that. I think it is a real problem, and you could probably get it published in some pretty decent places.

-t

 

[50960]

I had actually created s emi-article in my head for the journal of polymorphous perversity (if you don't know if it check it out), but I agree that this is a serious problem with our image. I have worked in medical settings for years, and I behave as though I am a colleague; I always get treated as an equal. I believe it is the inferiority complex that is the main cause of psychologists getting treated like the other "therapists".

 

[QPublic]

Thanks... and that sounds like a great article in the making!

Qpublic, I agree with you 100%, thanks for chiming in. I have written about this deferential way alot of psychologists have towards physicians not even knowledgeable in their area of specialty (IE family docs etc.). I have named this "PhD syndrome". Perhaps I should write an artilce about this??? LOL..

 

[em195]

Hi everyone, I've really enjoyed the discussion so far. I'm in my second year of medical school, and did my Master's and Ph.D. in basic science (oncology, molecular biology), and I know that the hierarchy of titles and degrees is certainly rampant in any academic area. (Try talking to the research technicians, who have decades of experience and brilliant scientific minds, but are always considered by the invisible ranking scheme to be "inferior" to the grad students! Blech.) I think it has a lot to do with the similarities between us all (those of us who enter a career in the medical sciences tend to be somewhat intelligent [though the student loans I'm rapidly acquiring make me question that one!], motivated to impact our chosen field of specialty, and genuinely driven by our desire to help the patients that we all see in various contexts) - similarity can certainly breed competition, and there is no shortage of that in academia!

It's clearly a silly and losing battle to try to 'best' each other. (That includes some of the comments suggesting that it's insulting to be considered at the same 'level' as an occupational therapist, speech-language pathologist, or nurse - don't forget, many of these professionals also obtain advanced degrees such as Ph.D.'s, do brilliant research, and have many years of training credentials.) In any field, there will always be individuals who are nothing short of a disgrace to their colleagues, and there will be gifted and talented people who set the best examples of what their profession can achieve. I hope that no one here will let a few negative interactions or environments colour their view of an entire profession!

That being said, I hope I can offer my opinion on one point without offending anyone - it's just my opinion, based on my hospital experiences so far: I personally feel that when you are in the presence of patients in the hospital, it is not appropriate to use the title "Doctor" to refer to anyone who does not hold an M.D. unless you are careful to include, "a clinical psychologist" or some other designation. I know that anyone who holds a Ph.D. in anything is properly addressed as "Doctor" in a professional and (should they chose it) social setting, and this is completely appropriate. As soon as I passed my defense, I took tremendous pride in being introduced as "Doctor" to new colleagues, at research presentations, etc. But if someone were to address me in that way at the bedside, in front of a patient, I would hurry to correct them, because (at least at the present time), when that title is used in a clinical setting, it DOES infer an M.D. to most people. (For example, I work with several nurses who hold Ph.D.'s, but I don't think anyone here would argue that it would be inappropriate for these professionals to expect to be called "Doctor" on the wards.) Is this just a semantic argument, and should anyone with clinical expertise and a doctorate be addressed this way in the clinical setting? - I would have absolutely no problem with this, IF we could be sure that the patients understood the designation. I know that if anyone asks for clarification it would quickly be provided, and I know that no one is trying to "pose" as something they are not. However, at least at the moment, when someone says they are "A doctor", this is still socially known to indicate someone holding an M.D., and until that definition is more widely accepted to encompass a more broad range of medical professionals, I find it inappropriate to assume that it would not be something of a deception to the patient. This is not to say that I think a patient would feel differently about a person's credentials or professional advice whether they were an M.D. or a Ph.D. It is simply that my ethical alarm bells go off when I consider any setting in which a patient might believe something incorrect about the person treating them - it is a basic tenant of informed consent and the patient-professional relationship.

That's just how I see it, and I welcome anyone with a different take on it to share how they feel about this! 🙂

 

[50960]

I totally disagree, however I see your points. I am a clinical psychologist who works exclusively in medical settings; I have never been referred to as anything other than Dr, although I always clarify that I am a psychologist as I hope any specialty would...I am Dr. so and so the consulting neurologist, psychiatrist, GI, Surgeon etc....but not attending or resident responsible for the whole care of the patient.
Professional who require a doctorate for their license sre and should be called Dr. A nurse, PT, OT, SLP etc.. who has an additional doctorate probably should not be called Dr as that is confusing...I am Dr. so and so, your nurse? The practice of psychology is totaly independent, unlike nurses and therapists. We can write orders, be on medical staffs, and require no supervision in any setting to work within the scope of our license. The Hx of doctor has little to do with physicanhood, and it is the responsibility of every practitiioner to make sure their patient is not under the impression they are a physician. This argument is really silly as I have never seen a situation in which a patient was harmed by thinking Dr. soand so, a consulting MD, psychologist etc... is actually their primary Dr.

 

[Therapist4Chnge]

The practice of psychology is totaly independent, unlike nurses and therapists. We can write orders, be on medical staffs, and require no supervision in any setting to work within the scope of our license. The Hx of doctor has little to do with physicanhood, and it is the responsibility of every practitioner to make sure their patient is not under the impression they are a physician. This argument is really silly as I have never seen a situation in which a patient was harmed by thinking Dr. so and so, a consulting MD, psychologist etc... is actually their primary Dr.

I totally agree.

With the heathcare system realizing the benefits of a team approach, it is much more common to have 'team' meetings. With these meetings everyone identifies themselves, and I'd find it a disservice to a person's education and status within the team to have something like this happen:

"i'm Dr. Smith, Oncology. I'm Dr. Jones, Surgery. I'm Bob, Psychologist." THAT would be a misrepresentation of Bob's title and status. On the other side, it would be just as problematic if a MHC called himself/herself a clinical psychologist, or a medical doctor calling themselves a specialist, when they did not receive the specialist training.

I plan on working in a hospital setting (medical psychologist), and i'll be damned if someone tries to call me "Bob" instead of "Dr. Smith".

-t

 

[50960]

Indeed, and the assumption that a primary care doctor, resident, attending has even a day's worth of knowledge about psychological aspects of treatment is absurd...just because they are a physician.

 

[sasevan]

I totally disagree, however I see your points. I am a clinical psychologist who works exclusively in medical settings; I have never been referred to as anything other than Dr, although I always clarify that I am a psychologist as I hope any specialty would...I am Dr. so and so the consulting neurologist, psychiatrist, GI, Surgeon etc....but not attending or resident responsible for the whole care of the patient.
Professional who require a doctorate for their license sre and should be called Dr. A nurse, PT, OT, SLP etc.. who has an additional doctorate probably should not be called Dr as that is confusing...I am Dr. so and so, your nurse?

I really like this distiction👍
When I was doing my fellowship at a med ctr I was Dr. Sasevan with patients and with other healthcare professionals, including physicians and nurses.
Psychology, just like dentistry, podiatry, optometry is a doctoral level healthcare profession and practitioners of those disciplines IMO are entitled to use the title Doctor in med ctrs. and in my experience do without any complaints from MDs, RNs, etc.
Nursing, therapy disciplines (PT, OT, RT) and other services (SW) are not doctoral level healthcare professions.
IMO only doctoral level AND healthcare disciplines practitioners are entitled to be called Doctor in med ctrs while interacting with patients; i.e., a DDS/DMD or DPM would be called Dr. but a DNP, DPT, DSW wouldn't and neither would a PhD in biochem or physics for that matter...again, talking about being in a med ctr and interacting with patients...in academic or professional settings a DNP, etc is entitled to be called Doctor.

 

[em195]

I totally disagree, however I see your points. I am a clinical psychologist who works exclusively in medical settings; I have never been referred to as anything other than Dr, although I always clarify that I am a psychologist as I hope any specialty would...I am Dr. so and so the consulting neurologist, psychiatrist, GI, Surgeon etc....but not attending or resident responsible for the whole care of the patient.

Um. We don't disagree, that's exactly what I said! 🙂

However, I don't agree that it doesn't cause harm for a patient to assume that the person they are talking to is something they aren't. As I said before, I do think it's a foundation of informed consent to treat that a patient be aware of the credentials and training of any person who is treating them in any way. Again, I'm not saying that this would detract in any way from the respect the patient has for the advice/treatment/care they recieve, but it IS important to be clear about who you are and in what capacity you are interacting with the patient.

 

[em195]

Indeed, and the assumption that a primary care doctor, resident, attending has even a day's worth of knowledge about psychological aspects of treatment is absurd...just because they are a physician.

Okay, now this is the kind of thing I was hoping to avoid! Why is there so much animosity about the physician thing? I can assure you that medical education focuses strongly on the psychologic aspects of health, disease, and treatment. Doesn't that go without saying?!🙁

 

[em195]

IMO only doctoral level AND healthcare disciplines practitioners are entitled to be called Doctor in med ctrs while interacting with patients; i.e., a DDS/DMD or DPM would be called Dr. but a DNP, DPT, DSW wouldn't and neither would a PhD in biochem or physics for that matter...again, talking about being in a med ctr and interacting with patients...in academic or professional settings a DNP, etc is entitled to be called Doctor.

I do agree with these distinctions, but do still feel that clearly identifying the context in which you are seeing the patient is important. - I think most of us do it anyway; you would never approach the bedside for the first time, give your title/name only, and start launching in to your business without first adding why you're seeing them and what you'd like to talk about/do.

 

[50960]

I agree, and that has been my experience as well.