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Do psychiatrists provide psychotherapy?
Started by Sylvia06
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I'm aware of this case. In theory, one might be able to carve out a legal pathway to admit patients without physician status. In practice, for better or for worse, there's no change since 1987.
I quoted you saying that psychologists don’t Work “well (if at all)” with Severe depression, bipolar disorder, suicidality, psychosis and I disputed your claim except for psychosis being the exception. Claiming later that you weren’t arguing that point doesn’t negate it.
Ultimately, it sounds like what you’re saying is that people’s biases will reflect their perception of psychotherapy competence as being superior in MDs regardless of level of training/expertise. Based on this thread, perhaps this bias toward the MD credential is (also)?occurring within psychiatrists.
I have yet to hear any specifics about the breakdown of hours of training in psychotherapy vs. other trainings in residency and how intensive it is (and how many psychotherapy clients one works with) so all I can gather is that it varies wildly and several psychiatrists I’ve encountered reported a lack of depth in psychotherapy training, with a couple of psychiatrists arguing that it’s extensive in this thread.
If anyone would like to provide specifics so I have a greater sample size of experiences to draw from, I’d like to see more. I’m also happy to share more details of PhD training, although I did provide a pretty long post about it for reference.
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You are correct on both accounts. The MD over PhD preference is, in essence, a recognition of prestige more than anything concrete. This is the same as credentialism in other domains. If you have two PhDs, one from Harvard, the other from not Harvard. The Harvard one will get paid more on average, despite the fact that the documented training appears exactly equivalent. Whether prestige reflects quality is a philosophical debate I'm not really interested in. I'm just giving you the hard facts.
To be fair: in general, my impression is that an FMG psychiatrist who went to a community residency program, is much less likely to build a cash therapy based practice than a PhD from a top program. So credentialism works both ways. There is a clear prestige ladder in this field, but that does not correspond necessarily in any material way to concrete training pathways or anything like that. Sometimes it does. Often it doesn't.
#DaddyIssues
LOL. Dude this is literally my job that I spent a decade in full time post-undergrad training for. Screw yourself.
You give people all the pills you want to stabilize symptoms in the present, while I sit over here and do the real work to facilitate long-term change and treatment progression.
One would hope that with a PhD you understand the difference between average and variance. I never implied that NO PhD does therapy with severe patients.
Then there's no argument here and no point to be made. I said I insist on using an appropriate metric so that my work is always data-informed. I never said I always use the same metric for all courses of therapy regardless of the goal (how stupid would that be? and how could anyone possibly have inferred that from my post?) so I think this conversation is closed.
Well that's pointless since nobody ever claimed that psychiatrists are the 'gold standard' for psychotherapy. Obviously a PhD psychologist has more training in this specific area than we do. I only said that I have *sufficient training to exercise a limited number of modalities competently.*
Given the vast sea of therapy woo out there, I'm having a hard time understanding why there is this desire to single out psychiatrists as uniquely undertrained.
Ok sure, whatever.
You implied that in general, PhDs don't get this training or do this work. I am here to tell you that this is untrue and your understanding of our training is not correct.
In general. You are operating outside of the general. It doesn't mean it's "completely untrue".
Ok, let me simplify for you:
IN GENERAL, PhDs get trained in how to do this work
I am not operating outside of the general. My peers do this work too.
Oh, boy, here we go...
So, you had material knowledge that directly contradicted your statement. And then made your statement knowing it was wrong?
Hint: Such laws are neither theoretical, nor limited to one state.
Come on. Play fair.
Not true. And one of your colleagues above said it agreed.
Psychologists don't admit/discharge psychotic patients. Most psychologists have never had inpatient exposure even during training.
There's no game here. If you want to be a doctor, go to med school.
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Sanman
O.G.
What exactly does progressive ideology or toxic liberalism have to do with turf wars in healthcare?
Who is gonna tell the MBBSes they need to go back to medical school to become "doctors"?
Oh my. Ask @tr They are an expert on that.
Sanman
O.G.
I am a doctor, got the title in front of my name and everything.
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Feel free to go to India and get an MBBS there. If you aren't happy with our immigration policy there's an appropriate forum to air your grievance.
lol i rest my case. the rest is trolling
Sanman
O.G.
Not sure what case you are resting? MBBS is based on the British system one need not go to India. The term doctor is based on the latin for "teacher", if you are going to argue about what school to go to in order to become a "doctor" check your history first.
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Why would most need this very specific thing? There ain't an inpatient unit on every street corner and most patients don't get hospitalized. Also most inpatients aren't there long enough or appropriate enough for psychological treatment.
I am a Dr. It is on my license and wall and everything. My boss and patients call me Dr. too.
I thought you just had a whole grandiose soapbox moment about individual data points directed at me. Now you are making these statements? I think you are just here to troll
But some psychiatrists are doing therapy also, not just slinging pills and y'all make fun of that too. Cognitive dissonance
I try to refer my patients to psychologists for therapy. However, they see lpc, msw, etc who I dont feel like have as much education
I plead the fifth. Take what you think is valuable. The rest is all trolling anyway.
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deleted343839
If you say so. That's way out there on the tail of the distribution for my market (major US city), though I'm sure a few of the big names can pull in that kind of fee.
The PhDs I personally know who are working in this space are licensed psychologists, but their roles in these ventures are owners, scientific officers, or other executives.
The competition is not just with PhD psychologists of which I only know a few in clinical psychology independent outpatient practice. It's with PsyD, lpc, life coach, msw, also. Many of which take insurance. So the competition is high
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deleted343839
So, consumer perception is "neither here nor there" but...
What are you trying to say?
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Right. Some psychologists are working on technology that will outsource away other psychologists' jobs. This is not good news no matter how you look at it.
This outsource/AI thing IMO in the therapy field is a much bigger problem than say in things like radiology. The thing that AI cannot take is liability. And therapists by design have little. This is a blessing and a curse.
What I'm trying to say is that given the market reality, if you are a top student and want to be a therapist and make a lot of money and are indifferent to prescribing medications and seeing sick patients in the ER, you should probably aim for a top medical school and top residency rather than a top PhD and a top internship.
If you are an average student, being at an average US based medical school, which typically guarnetee you a spot at a university based resdiency program, probably still trumps being at an average PhD program, though things start to be more ambiguous vs. top 5 PhD programs.
If you are talking about Caribean medical schools or being a frank FMG vs. clinical psychology, things are less clear cut, and the tradeoffs are already discussed. MDs with that background tend to end up doing very little therapy. They might do a little bit but will be taking a pay cut. The PhDs will have a large variance in terms of practice settings, but in general at that level they don't get paid very well at all, and it's debatable if the investment in time/effort is worth the PhD vs. master-level credentials.
Typically, the actual underlying question of "do psychiatrists provide psychotherapy" boils down to the above.
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Agreed. Which is what this thread has been trying to figure out (with much difficulty)....What exactly that therapy practice looks like in your field, the training requirements, professional oversight and ethics, etc.
Roger that. Appreciate the candor.
The main issue that you and I both know is that PhDs just didn't protect their turf well, and therapy is a harder turf to protect than meds or even meds + therapy. And since meds in general move faster than therapy, it's a present and future problem. MDs are one CME away from cutting edge meds that NPs don't know what to do with. Therapy is full of woo woo and many therapists don't even believe in science. I don't have an answer for you but cutting down on the number of slots and centrally manage labor supply would help. However, nobody is willing to do this.
sluox is making fun of me for being a bleeding heart liberal. Carry on, I wear my ideology proudly.
Don't worry sluox, I'm doing four-figure teleconsults on the side, so I can easily support my bleeding-heart Medicare psychotherapy habit. 😉
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deleted343839
100% agree. This is what I typically tell people interested in a "therapy" career, and is not inconsistent with anything else I wrote above.
Time will tell. I don't see much evidence for this so far.
As for mHealth, the people in my network who are involved in these ventures are mostly working in niche areas (pain, behavioral medicine) that most psychologists in the community are poorly equipped to deal with. They're marketing to therapists (as tools to use in their practice rather than to duplicate their work), and also to pharma and healthcare institutions.
There's a lot of nonsense in this thread, but I think @Sanman posted a summary of the crux of the issue for two sides of this conversation, which I'll try to restate and summarize for my own take away:
1. Are psychiatrists practicing to the "gold standard" of psychotherapy? Some, perhaps, but from the sounds of it their training is at best comparable to master's level counselors (and there is significant doubt as to whether or not this is true). In other words, if we were to look at the distribution of quality/quantity of training in psychotherapy practice for MDs, the mean would probably be below that of an LICSW or LMHC and the SD would probably be larger.
2. There is not currently a professional organization that is effectively protecting the compensation-for-quality of psychotherapy in the same way the AMA/ApA has and continues to protect psychiatric prescription privileges. The consequence of this is that insurance will compensate PhD, MD or LICSW at roughly the same rates.
If the questions is "I'm interested in a 'therapy' career and want to get the highest quality training I can in providing effective therapy, what should I do?" Then, to my mind, the answer is PhD. This is the conclusion I came to before I decided about graduate training, after having a number of candid conversations with professionals in medicine, social work, and psychology.
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Mod Note: I'm glad we were able to steer back, in some capacity, to the original topic of the thread. Thanks all.
And a friendly reminder for us all to please remain professional, and perhaps even collegial, in our responses.
And a friendly reminder for us all to please remain professional, and perhaps even collegial, in our responses.
This thread is missing the point that psychotherapy is not the sole source of income for many psychologists. Arguing that a Ph.D. "isn't worth it" when compared to a master's degree just on the premise of low insurance reimbursements for psychotherapy ignores that fact. From what I've seen, most people on this forum tell people who want sole therapy careers to get an MSW.
Citation?
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deleted343839
I used to think more along these lines.
Over time, I've seen psychologists in the community doing dubious things despite having trained at reputable programs. And I've befriended psychiatrists who appreciate psychotherapy and take it upon themselves to learn more to enhance their skills. Also, I've come to appreciate that expectancies are incredibly powerful, and having a credential that elicits strong positive expectancies is an underappreciated asset. Finally, I want people to have lots of career options and to do well for themselves.
All those things considered, I encourage most people interested in clinical careers to strongly consider medicine unless they just have no interest at all in any other aspects of the profession. For people who want careers that look more like mine (half-time clinical or less), or traditional academic careers, I'm more likely to steer them toward psychology. But I'm very cautious in any case, because clinical psychology is an evolving field, riddled with problems, and we can't agree on the solutions even at pretty basic levels. I feel it is the responsible thing to do to be cautious before recommending it as a career.
For what it's worth, I agree that we're better trained in behavioral therapies, but the field has been very slow to demonstrate the value of that enhanced training, and healthcare delivery systems aren't going on any fact-finding missions on our behalf.
Couldn't agree more with what you've said. I think an interesting question -- perhaps to discuss in another thread -- is how to magnify positive expectancies for psychologists. A big part of the reason I dress the way that I dress is I think it contributes to my patients' positive expectancies.
All things being equal (intervention, provider personality, patient condition, etc.), for most citizens of developed nations, an MD is going to produce more positive change in mental health outcomes than any other credential (psychologist, counselor, etc.) due to those positive expectancies. I think a large part of that is the protection of "turf" that MDs get so criticized for -- they've been able to prevent their professional credential from being watered down by sub-standard training and competence. It's about more than just "turf" or billing or privileges, because perception actually impacts patient outcomes, and for that reason alone it should be really important to our field.
Personally, I did not go to a psychotherapy oriented residency. I did, however, look up some places that seem to be more invested in therapy training for psychiatrists. Their websites actually had some specific information about what training looks like if you're interested:
medschool.ucsd.edu
Psychotherapy Training - Psychiatry Residency Program - UC San Diego
In depth training in psychotherapy begins in the PG1 year and builds throughout the 4 years of training at UCSD. During the first year, Interns are taught basic principles of interviewing, communication and supportive psychotherapy
Psychotherapy | Residency Training Program | Perelman School of Medicine at the University of Pennsylvania
Welcome to the Penn Psychiatry Residency Program!! We're very pleased that you're considering applying to Penn, and we hope you will peruse our website, talk to our residents, faculty and us about what our residency has to offer. Penn Psychiatry is a warm, collegial, cohesive, family-friendly...
www.med.upenn.edu
The state medical board oversees us. Just like the Psychology Board monitors RxPs. I choose CME's that have therapy. Sometimes there are CME's so I just do CE's that therapists do. Its for knowledge then. but not credit for my State Board. My state board is 150 CME in 3 years.
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Our "turf" is being invaded by midlevels and psychologists.
And I know when to refer patients, and certainly all patients don't like the therapy I give, just like for anyone.
I refer to psychologists only, and ones that I have worked with.
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deleted343839
Personally, I did not go to a psychotherapy oriented residency. I did, however, look up some places that seem to be more invested in therapy training for psychiatrists. Their websites actually had some specific information about what training looks like if you're interested:
Psychotherapy Training - Psychiatry Residency Program - UC San Diego
In depth training in psychotherapy begins in the PG1 year and builds throughout the 4 years of training at UCSD. During the first year, Interns are taught basic principles of interviewing, communication and supportive psychotherapyPsychotherapy | Residency Training Program | Perelman School of Medicine at the University of Pennsylvania
Welcome to the Penn Psychiatry Residency Program!! We're very pleased that you're considering applying to Penn, and we hope you will peruse our website, talk to our residents, faculty and us about what our residency has to offer. Penn Psychiatry is a warm, collegial, cohesive, family-friendly...www.med.upenn.edu
It's not a coincidence that these institutions also house very strong psychotherapy research programs. Note that over half of the advisory committee for the Penn residency's psychotherapy track are psychologists.
Same citation as the admitting privileges statement. Made up from someone who makes statements despite material knowledge to the contrary
I think the LA medical board would be surprised to learn that that don’t oversee RxPers.
In Illinois, it's psychology board.
Whats it in New Mexico and the other states?
How many psychotherapy patients were you seeing during the week?
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