Do you regret not pursuing psychology?

[MustIReallyThough]

Hello! I am a psychology student currently debating grad and medical school. I am wondering if anyone here thinks they would have been happier, more impactful, more fulfilled, etc., if they had gone through a PhD psychology program instead, mainly in terms of patient care than anything related to research. Also, if any psychologists wander in I'd love to hear their thoughts on the reverse of this question.

Extraneous information: I know its hard to measure these "what-ifs" but I'm curious if it elicits any specific thoughts or if I shouldn't worry about it at all. I have encountered numerous threads in my internet poking in which therapists and even a few psychologists regret their decision in favor of medicine for reasons relating to pay, job security, and schooling. As of yet I don't think I've read anything inversed. Of course, I'm sure many of those people haven't fully grasped how damn hard the medical path is. Also, a big thanks to everyone who has previously responded thus far to my questions. I hope y'all don't mind if I pop in every now and then as I continue to figure things out.

Thanks!

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[Sushirolls]

Nope. Never even thought about it before med school.

Didn't even think of Psychiatry early in medical school.

 

[jbomba]

Absolutely not. I want to prescribe medicine and do therapy. I also want the (much) larger paycheck.

 

[MustIReallyThough]

Absolutely not. I want to prescribe medicine and do therapy. I also want the (much) larger paycheck.

How much therapy are you able to do as a resident (if you still are one)? From what I understand it is a very minimal part of the job. But the potential there is alluring.

 

[thepoopologist]

If we're going with "what-ifs" I would've preferred becoming independently wealthy via bitcoin or the stock market. Spending my days on a boat next to my lakeside home being served hor d'oeuvres by my butler. Basically, Bruce Wayne

As far as working for a living in the context of being an average joe, I prefer my current occupation.
1. Government paycheck continues to arrive on time. Sure, I worry about finances, but I would probably worry more on 1/3 the salary.
2. I'm telepsychiatry so I haven't had direct contact with anyone for 2 years.
3. Psychiatry is interesting to me within the physician lens. Sure, maybe psychology would've been a decent choice too, who knows.

 

[MustIReallyThough]

If we're going with "what-ifs" I would've preferred becoming independently wealthy via bitcoin or the stock market. Spending my days on a boat next to my lakeside home being served hor d'oeuvres by my butler. Basically, Bruce Wayne

As far as working for a living in the context of being an average joe, I prefer my current occupation.
1. Government paycheck continues to arrive on time. Sure, I worry about finances, but I would probably worry more on 1/3 the salary.
2. I'm telepsychiatry so I haven't had direct contact with anyone for 2 years.
3. Psychiatry is interesting to me within the physician lens. Sure, maybe psychology would've been a decent choice too, who knows.

Hah, alright, its hard to compare to Bruce Wayne. Unless your stocks fall through, then you're just Bruce. Not the greatest name eh?

I suppose it isn't as important a question as I thought it would be. Perhaps it is on the psychology side, but mainly with masters folks as they really get the short end of the stick. I guess if I can make it through med school I should be content.

 

[thepoopologist]

Hah, alright, its hard to compare to Bruce Wayne. Unless your stocks fall through, then you're just Bruce. Not the greatest name eh?

I suppose it isn't as important a question as I thought it would be. Perhaps it is on the psychology side, but mainly with masters folks as they really get the short end of the stick. I guess if I can make it through med school I should be content.

Its hard, because its a huge time commitment either way.

Its a job/career and job security is nothing to sneeze at but considering the time commitment you should also like it enough to get out of bed most mornings.

 

[MustIReallyThough]

Its hard, because its a huge time commitment either way.

Its a job/career and job security is nothing to sneeze at but considering the time commitment you should also like it enough to get out of bed most mornings.

Honestly, I'd rather do the work than be Bruce or Wayne at the moment. I'm probably still young enough that I haven't gotten my **** entirely kicked out of me yet, but its all I've ever wanted to do. Couldn't imagine anything else and I've really tried.

 

[rjs2131]

Generally - you can do a mix of therapy and med management (or 100% therapy if you really want but that’s much less common) as a psychiatrist. Psychologists generally don’t have the option to choose and are clinically either doing therapy or research from what I’ve seen.

Not sure why a psychiatrist would ever go back and choose to be a psychologist...less flexibility, less pay, less job options.

 

[wolfvgang22]

I worked towards PhD in psychology (part of one semester), but quickly dropped out in favor of med school when I saw how poor the compensation is compared to physicians despite all the work and time invested. I kind of felt bad about getting accepted and taking someone else's spot.

 

[MustIReallyThough]

Generally - you can do a mix of therapy and med management (or 100% therapy if you really want but that’s much less common) as a psychiatrist. Psychologists generally don’t have the option to choose and are clinically either doing therapy or research from what I’ve seen.

Not sure why a psychiatrist would ever go back and choose to be a psychologist...less flexibility, less pay, less job options.

Do you think the intense training of medical school would cause someone primarily interested in the health of the mind to regret the decision? But I suppose a PhD is no walk in the park either. I'm also coming from a perspective where I've always thought I'd make a better therapist. But I suppose I really could tailor my practice to my strengths

 

[MustIReallyThough]

I worked towards PhD in psychology (part of one semester), but quickly dropped out in favor of med school when I saw how poor the compensation is compared to physicians despite all the work and time invested. I kind of felt bad about getting accepted and taking someone else's spot.

Were you and are you interested in practice more than research?

It's a stark comparison for sure. I suppose even the huge debt of med school is somewhat negated in comparison by how long PhDs are now. Also most PhDs seem to come out with some amount of debt even in paid programs.

 

[Splenda88]

Are you really asking people who are making 300-400k working 40 hrs/wk if they regret pursuing another career (in that case, psychology) where income of 100k is considered outstanding?

There is a reason why getting into med school is extremely competitive...

 

[rjs2131]

Do you think the intense training of medical school would cause someone primarily interested in the health of the mind to regret the decision? But I suppose a PhD is no walk in the park either. I'm also coming from a perspective where I've always thought I'd make a better therapist. But I suppose I really could tailor my practice to my strengths

You’ll find that your interests/strengths change as you go through school and get older - med school gives you plenty of options, PhD not so much. Everyone’s different but personally, med school always seemed more interesting than several years of reading/writing papers/etc to get a PhD.

 

[MustIReallyThough]

Are you really asking people who are making 300-400k working 40 hrs/wk if they regret pursuing another career (in that case, psychology) where income of 100k is considered outstanding?

There is a reason why getting into med school is extremely competitive...

I hear ya, not all about the money though. Mainly I was curious if I'd hear anything about the rigours of training/interning. Or from folks who had more of a passion for psychology than medicine in school and may now feel out of place. Perhaps also someone who could relate any stories of colleagues who didn't match psychiatry?

 

[MustIReallyThough]

You’ll find that your interests/strengths change as you go through school and get older - med school gives you plenty of options, PhD not so much. Everyone’s different but personally, med school always seemed more interesting than several years of reading/writing papers/etc to get a PhD.

Agreed, I'm no raging extrovert but would still prefer intense interning to writing a paper I think. That just sounds awful. Thanks for your responses man! I'm getting pretty sure of where I'm headed

 

[wolfvgang22]

Were you and are you interested in practice more than research?

It's a stark comparison for sure. I suppose even the huge debt of med school is somewhat negated in comparison by how long PhDs are now. Also most PhDs seem to come out with some amount of debt even in paid programs.

Yes.

 

[splik]

I am frequently mistaken for a psychologist. A lot of people don't seem to know the difference.

I think it is unlikely you would find any psychiatrists who wish they had been psychologists.
One thing I will say is that psychiatry could learn a lot from psychology in terms of their model of training. Clinical psychology training at reputable programs is based on the scientist-practitioner model that emphasizes a scholarly approach to mind and mental disorder, and an empirical and theoretical basis to the assessment and treatment of psychological disorders. Psychiatry on the other hand is atheoretical at best (see DSM) and mired in pseudoscience at worst. Psychiatry has been historically very unwilling to apply a critical gaze which has left it particularly prone to fads, and has caused a lot of harm to patients in the process, which it has denied or denounced. The other thing that is less of a problem in clinical psychology (though clinical psychologists in some roles grapple with this) but inherent to psychiatric training is coercion. It is unlikely you would get through psychiatry training without "treating" patients against their will, whereas it is less common for psychology trainees to get this experience (though I train psychology interns in acute settings, so some programs do provide this experience). It is ethically fraught and can be distressing and frustrating working with patients who do not wish to receive treatment, and it can be hard to know when you are helping or causing harm. There is also a vocal minority who hold a special contempt for psychiatrists who do not have the same contempt for psychologists.

So while I don't wish I were a psychologist (and I have mixed feelings when I see myself described as one), I think psychiatry could learn a lot from clinical psychology. I wish there were more grounding in psychiatry residency training in social sciences, cognitive, developmental and social psychology, philosophy, critical thinking and evidence-based practice and think the field would benefit from more scholarly publications which are rare in psychiatry as compared to psychology.

 

[rikudo]

Psychology PhD's/PsyD guarantee you a psych degree upon completion, med school doesn't. This year's match looks brutal, psych is no longer a sure thing. Someone attending med school should be prepared to be any kind of doctor.

 

[MustIReallyThough]

Psychology PhD's/PsyD guarantee you a psych degree upon completion, med school doesn't. This year's match looks brutal, psych is no longer a sure thing. Someone attending med school should be prepared to be any kind of doctor.

This is a huge factor to me. However, others have counseled that it shouldn't be a deciding factor or even something I should be worried about at this point. So I'm a little unsure how to feel. As one poster mentioned, I would probably follow his own path in which I had a primary interest in psychiatry but in the end would have been happy in a few other places as well. I don't know. If someone doesn't match are they forever barred from that specialty?

 

[MustIReallyThough]

I am frequently mistaken for a psychologist. A lot of people don't seem to know the difference.

I think it is unlikely you would find any psychiatrists who wish they had been psychologists.
One thing I will say is that psychiatry could learn a lot from psychology in terms of their model of training. Clinical psychology training at reputable programs is based on the scientist-practitioner model that emphasizes a scholarly approach to mind and mental disorder, and an empirical and theoretical basis to the assessment and treatment of psychological disorders. Psychiatry on the other hand is atheoretical at best (see DSM) and mired in pseudoscience at worst. Psychiatry has been historically very unwilling to apply a critical gaze which has left it particularly prone to fads, and has caused a lot of harm to patients in the process, which it has denied or denounced. The other thing that is less of a problem in clinical psychology (though clinical psychologists in some roles grapple with this) but inherent to psychiatric training is coercion. It is unlikely you would get through psychiatry training without "treating" patients against their will, whereas it is less common for psychology trainees to get this experience (though I train psychology interns in acute settings, so some programs do provide this experience). It is ethically fraught and can be distressing and frustrating working with patients who do not wish to receive treatment, and it can be hard to know when you are helping or causing harm. There is also a vocal minority who hold a special contempt for psychiatrists who do not have the same contempt for psychologists.

So while I don't wish I were a psychologist (and I have mixed feelings when I see myself described as one), I think psychiatry could learn a lot from clinical psychology. I wish there were more grounding in psychiatry residency training in social sciences, cognitive, developmental and social psychology, philosophy, critical thinking and evidence-based practice and think the field would benefit from more scholarly publications which are rare in psychiatry as compared to psychology.

Interesting! I'll keep what you've said in mind about patient relations. The schooling for psychologists does seem impressive and alluring as well besides the personal research. I don't think I'd mind the pay cut as well if that would be the best option for me, though it is huge.

Do you have any thoughts about increasing residency competition like the above post mentioned?

 

[WisNeuro]

Are you really asking people who are making 300-400k working 40 hrs/wk if they regret pursuing another career (in that case, psychology) where income of 100k is considered outstanding?

There is a reason why getting into med school is extremely competitive...

Not very accurate, especially in certain specialty areas of psychology. Recent salary surveys bear this out. Additionally, fairly easy to supplement with IME work which compensates at several hundred per hour on the low end.

 

[clausewitz2]

I am frequently mistaken for a psychologist. A lot of people don't seem to know the difference.

I had a PhD supervisor in my third year who walked into our shared office one day and declared, "I've been thinking, and you're not really a psychiatrist." I was somewhat taken aback and don't think I managed more than a puzzled expression, so he clarified: "You have a psychologist's mindset and don't seem to think like they do, so you're not really a psychiatrist." I did my best to take this as a compliment. There must be something to it, as throughout training I often found myself having more interesting and longer conversations with psych interns and other psych PhDs than many of my psychiatric MD supervisors/colleagues and I definitely use more of what I took away from those conversations on a regular basis and when formulating patients. So sure, there's definitely a part of me that wants to be on that side of things more, but at the end of the day I think I made the right choice for my life.

As an amateur philosopher of psychiatry who someday will be submitting some pieces for publication, honest, I agree wholeheartedly with @splik. For now I try to do my part by teaching history and philosophy of psychiatry didactics to trainees from my old program. A small drop in the bucket but it is hard to be even vaguely cognizant of the history of our field outside of potted hagiography and not start to develop a somewhat critical eye regarding how much credence to put into whatever trendy new treatment is the hotness right now.

 

[splik]

Interesting! I'll keep what you've said in mind about patient relations. The schooling for psychologists does seem impressive and alluring as well besides the personal research. I don't think I'd mind the pay cut as well if that would be the best option for me, though it is huge.

Do you have any thoughts about increasing residency competition like the above post mentioned?

There is a huge range of income for psychologists and psychiatrists. While employed positions for psychologists are often substantially less than for psychiatrists, there are still decently paid positions within the VA, the federal and state prison system (particularly for forensic psychologists), some state hospitals, and other government facilities. In addition, there are many psychologists in private practice who make as much if not more than psychiatrists. I know of a psychologist who charges $600/hr for expert witness work (which slightly more than what I charge). I also get frequently mistaken by attorneys as a psychologist so I can only assume my fees are not dissimilar to what they might pay a psychologist expert witness (or I'm not charging enough!). Similarly, good clinical psychologists in my area charge $250-300/hr for therapy which is comparable or more than what many psychiatrists charge doing both therapy and meds. Obviously, we are talking about people at the top end of the scale (and similarly top end psychiatrists charge $600/hr for clinical work and 900+/hr for expert witness work) but my point is that well trained clinical psychologists in certain markets make more than what is the median income for a psychiatrist.

As for competition for psych residencies - between 1 in 5 and 1 in 6 psychiatrists residents is an IMG. IMGs are appointed for positions which there are no comparably qualified US medical students or graduates. While psychiatry is not anywhere near as easy to match into as in the 90s or early 2000s, it is not a competitive specialty. It is just more competitive than it used to be. The vast majority of medical students have no interest in psychiatry whatsoever. This is not likely to change. What is changing is there are more medical students and they are more likely to be attracted to specialties that have a better work-life balance than was the case in the past.

 

[Stagg737]

This is a huge factor to me. However, others have counseled that it shouldn't be a deciding factor or even something I should be worried about at this point. So I'm a little unsure how to feel. As one poster mentioned, I would probably follow his own path in which I had a primary interest in psychiatry but in the end would have been happy in a few other places as well. I don't know. If someone doesn't match are they forever barred from that specialty?

They are not. Many individuals will transfer programs or even specialties after their intern year. You can do a transitional year and apply again the following year. You can even complete a residency and reapply afterwards if you want to switch fields. One of the best attendings in my program started her career as an ophthalmologist and changed to psychiatry later to spend more time with family.

In terms of your original question, I never considered psychology over psychiatry and in fact was about 99% sure I would not do psychiatry until my M3 rotation. I'm still in residency, but in retrospect I would not choose psychology over psychiatry. Much more career flexibility and security with psychiatry, generally better pay, and wider breadth of knowledge (medical) makes psychiatry the winner for me hands down. That being said, I agree with the above that there should be a heavier emphasis on psychology in our residencies and that a lot of psychiatrists pigeon-hole themselves to the "medical" side of the field.

 

[Ole_Toe]

As for competition for psych residencies - between 1 in 5 and 1 in 6 psychiatrists residents is an IMG. IMGs are appointed for positions which there are no comparably qualified US medical students or graduates. While psychiatry is not anywhere near as easy to match into as in the 90s or early 2000s, it is not a competitive specialty. It is just more competitive than it used to be. The vast majority of medical students have no interest in psychiatry whatsoever. This is not likely to change. What is changing is there are more medical students and they are more likely to be attracted to specialties that have a better work-life balance than was the case in the past.

If you are capable of gaining admission to a USMD (or DO), then you should feel confident about matching into psychiatry. Of course, if you are seriously geographically limited or only interested in specific academic programs, then your odds of disappointment are higher. This is also true for the highly competitive clinical psychology phd programs. As splik mentioned, many who do not match in psychiatry are IMGs or even *US med students who apply to psychiatry as a backup. If you enter a US medical school with a desire to pursue psychiatry, you will match somewhere.

 

[Psychresy]

This is a huge factor to me. However, others have counseled that it shouldn't be a deciding factor or even something I should be worried about at this point. So I'm a little unsure how to feel. As one poster mentioned, I would probably follow his own path in which I had a primary interest in psychiatry but in the end would have been happy in a few other places as well. I don't know. If someone doesn't match are they forever barred from that specialty?

If you go into med school with a distinct desire to apply psychiatry and take the appropriate steps while in school, you will match psychiatry. The people who don't match are largely IMGs and people using it as a backup. I had people in my class with board failures who matched psychiatry. This would never be the case for a field like plastic surgery, radiology, etc.

 

[psychacad]

In general from my clinical interactions, I did not think psychologists were very good in the acute setting with things like detecting delirium, in differential diagnosis particularly when it comes to SMI. In psychiatry you will see and manage far more patients in residency and imo you will get a richer understanding in nuances and the range of disturbances in mental behavior. And as mentioned, you will be much better skilled in dealing with patients who did not come to treatment out of their own volition. You will obviously not get the same exposure to therapy, but this is totally possible to do after residency. No regrets whatsoever on my part.

 

[tr]

I don't think the OP will get many useful answers to this question because I do not think there are very many psychiatrists who saw their career paths as choices between psychiatry and psychology. The decision point is medical school vs PhD/PsyD and most med school applicants are generally focused on becoming doctors, without a specific specialty in mind. Most of those who enter with a specialty in mind end up changing their minds anyway. So the question of whether we would rather have been psychologists isn't much more compelling than the question of whether we would rather have been architects or lawyers. For most of us, those probably weren't pathways we seriously considered.

 

[DD214_DOC]

I don't think the OP will get many useful answers to this question because I do not think there are very many psychiatrists who saw their career paths as choices between psychiatry and psychology. The decision point is medical school vs PhD/PsyD and most med school applicants are generally focused on becoming doctors, without a specific specialty in mind. Most of those who enter with a specialty in mind end up changing their minds anyway. So the question of whether we would rather have been psychologists isn't much more compelling than the question of whether we would rather have been architects or lawyers. For most of us, those probably weren't pathways we seriously considered.

I sort of did, actually. My undergrad ended up being in psychology because I quickly realized the depth one could go during the freshman intro psych course. The course itself wasn't that way, obviously, but I found myself spending time outside of class discussing concepts and pretty deep stuff with the professors.

I actually started out as, "premed", intending to become a surgeon. The psychology exposure and experience during undergrad started the process that would change my eventual specialty and I did actually consider grad school for psychology and looked into it, but ultimately decided it could be a potential backup plan in the event med school didn't happen for me.

In retrospect, I'm glad I stuck with med school and the psychiatrist route. The additional background in psychology and additional interest/learning in it was certainly helpful and are, surprisingly, things that aren't covered in much detail in psych residency. Fundamental things such as learning theory, reinforcement, and so forth are crucial concepts to understand in depth and I could tell many of my fellow residents in general psych training were rather lacking in this understanding, having only a superficial knowledge of it.

Also, the non-psychiatric medical knowledge, experience, and training are vital to what I do. It isn't every day or every patient, but understanding when and how to rule out potential medical etiologies to a presentation has served me well and I cannot imagine how anyone could do this without that ability. Just be sure you supplement it by learning the non-medication talky talky stuff from very competent psychologists and attend a residency program that has good therapy training.

I may not do identifiable, "therapy sessions", with every patient, but I use the principles, techniques, concepts, and understanding of all that stuff every day with every patient.

 

[heartsink]

Psychology PhD's/PsyD guarantee you a psych degree upon completion, med school doesn't. This year's match looks brutal, psych is no longer a sure thing. Someone attending med school should be prepared to be any kind of doctor.

This year's match is also in the midst of medicine's version of a black swan event.

 

[MustIReallyThough]

There is a huge range of income for psychologists and psychiatrists. While employed positions for psychologists are often substantially less than for psychiatrists, there are still decently paid positions within the VA, the federal and state prison system (particularly for forensic psychologists), some state hospitals, and other government facilities. In addition, there are many psychologists in private practice who make as much if not more than psychiatrists. I know of a psychologist who charges $600/hr for expert witness work (which slightly more than what I charge). I also get frequently mistaken by attorneys as a psychologist so I can only assume my fees are not dissimilar to what they might pay a psychologist expert witness (or I'm not charging enough!). Similarly, good clinical psychologists in my area charge $250-300/hr for therapy which is comparable or more than what many psychiatrists charge doing both therapy and meds. Obviously, we are talking about people at the top end of the scale (and similarly top end psychiatrists charge $600/hr for clinical work and 900+/hr for expert witness work) but my point is that well trained clinical psychologists in certain markets make more than what is the median income for a psychiatrist.

As for competition for psych residencies - between 1 in 5 and 1 in 6 psychiatrists residents is an IMG. IMGs are appointed for positions which there are no comparably qualified US medical students or graduates. While psychiatry is not anywhere near as easy to match into as in the 90s or early 2000s, it is not a competitive specialty. It is just more competitive than it used to be. The vast majority of medical students have no interest in psychiatry whatsoever. This is not likely to change. What is changing is there are more medical students and they are more likely to be attracted to specialties that have a better work-life balance than was the case in the past.

Those ranges are significantly more than anything I've read or heard of and a bit surprising. I wonder how common it is to reach that level...5% or even less? In any case, I'm certainly not afraid of ending up poor if I go the psych route. More focused on comparing the specifics of clinical work and training experience. Prior posts and digging have led to be believe psychiatry would better suit a clinical career.

Also, thank you and others on your input about residency. Consensus again seems to declare it a nonissue, as long as I don't box out a patient or something. I'll try to be Bruce instead of Bruce Wayne.

What is changing is there are more medical students and they are more likely to be attracted to specialties that have a better work-life balance than was the case in the past.

Still, would this not concern you if you were in my shoes? Or do you mean that is the reason its rising in popularity but still not that competitive.

 

[MustIReallyThough]

They are not. Many individuals will transfer programs or even specialties after their intern year. You can do a transitional year and apply again the following year. You can even complete a residency and reapply afterwards if you want to switch fields. One of the best attendings in my program started her career as an ophthalmologist and changed to psychiatry later to spend more time with family.

In terms of your original question, I never considered psychology over psychiatry and in fact was about 99% sure I would not do psychiatry until my M3 rotation. I'm still in residency, but in retrospect I would not choose psychology over psychiatry. Much more career flexibility and security with psychiatry, generally better pay, and wider breadth of knowledge (medical) makes psychiatry the winner for me hands down. That being said, I agree with the above that there should be a heavier emphasis on psychology in our residencies and that a lot of psychiatrists pigeon-hole themselves to the "medical" side of the field.

Wow, well that doesn't sound too bad at all. Maybe I'm missing something? I'd gladly take a transitional year if that's what it took. The feeling I got from other posts concerning not matching was that they were forever screwed for some reason or another.

 

[MustIReallyThough]

In general from my clinical interactions, I did not think psychologists were very good in the acute setting with things like detecting delirium, in differential diagnosis particularly when it comes to SMI. In psychiatry you will see and manage far more patients in residency and imo you will get a richer understanding in nuances and the range of disturbances in mental behavior. And as mentioned, you will be much better skilled in dealing with patients who did not come to treatment out of their own volition. You will obviously not get the same exposure to therapy, but this is totally possible to do after residency. No regrets whatsoever on my part.

Do you mind sharing your experiences with therapy after residency? Wondering how much you went through and if you now incorporate it in your work.

 

[MustIReallyThough]

I sort of did, actually. My undergrad ended up being in psychology because I quickly realized the depth one could go during the freshman intro psych course. The course itself wasn't that way, obviously, but I found myself spending time outside of class discussing concepts and pretty deep stuff with the professors.

I actually started out as, "premed", intending to become a surgeon. The psychology exposure and experience during undergrad started the process that would change my eventual specialty and I did actually consider grad school for psychology and looked into it, but ultimately decided it could be a potential backup plan in the event med school didn't happen for me.

In retrospect, I'm glad I stuck with med school and the psychiatrist route. The additional background in psychology and additional interest/learning in it was certainly helpful and are, surprisingly, things that aren't covered in much detail in psych residency. Fundamental things such as learning theory, reinforcement, and so forth are crucial concepts to understand in depth and I could tell many of my fellow residents in general psych training were rather lacking in this understanding, having only a superficial knowledge of it.

Also, the non-psychiatric medical knowledge, experience, and training are vital to what I do. It isn't every day or every patient, but understanding when and how to rule out potential medical etiologies to a presentation has served me well and I cannot imagine how anyone could do this without that ability. Just be sure you supplement it by learning the non-medication talky talky stuff from very competent psychologists and attend a residency program that has good therapy training.

I may not do identifiable, "therapy sessions", with every patient, but I use the principles, techniques, concepts, and understanding of all that stuff every day with every patient.

Fascinating! This is pretty much in line with my own thinking. I've loved studying psychology, but think I'd like to limit further informal study to only clinically relevant information. I feel like I'd be bored to tears learning about anything that wasn't or about extremely specific things, which is my understanding of PhDs. I have no great questions really, just wanna wade in and care for some people.

Thanks for that perspective! Also, what has your experience been with therapy training? How often are you able to work it in your job?

 

[DuskPhilosophy]

I was a psychology major, fell in love with family therapy during my junior year and started to toss around the idea of MFT vs PhD vs PsyD vs MD during spring of junior year. I made spreadsheets of all the different programs in the states I would consider living in and interviewed with a number of psychologists and psychiatrists before ultimately deciding that going to medical school would be the easiest way for me to provide as much care to my patients as possible. I am now in my final year, about to be a child psychiatrist and I couldn't be happier with my decision. Yes medical school is rigorous but it was also a ton of fun and i really enjoyed what I learned and even flirted with a few other specialties before committing down the psych path. I don't know for sure but I would venture to say that if you volunteer or do some scholarly activities related to psych during medical to show your commitment to the specialty, you will likely have no issues matching if no other red flags. I'll admit, the program where I trained did not lend itself to the psychotherapy training that I pictured for myself but I am doing the things is need to to supplement that training and plan on continuing to do so once done with training so that I can feel confident in my skills as a therapy providing psychiatrist. Feel free to PM if you want more details.

 

[birchswing]

I am frequently mistaken for a psychologist. A lot of people don't seem to know the difference.

I think it is unlikely you would find any psychiatrists who wish they had been psychologists.
One thing I will say is that psychiatry could learn a lot from psychology in terms of their model of training. Clinical psychology training at reputable programs is based on the scientist-practitioner model that emphasizes a scholarly approach to mind and mental disorder, and an empirical and theoretical basis to the assessment and treatment of psychological disorders. Psychiatry on the other hand is atheoretical at best (see DSM) and mired in pseudoscience at worst. Psychiatry has been historically very unwilling to apply a critical gaze which has left it particularly prone to fads, and has caused a lot of harm to patients in the process, which it has denied or denounced. The other thing that is less of a problem in clinical psychology (though clinical psychologists in some roles grapple with this) but inherent to psychiatric training is coercion. It is unlikely you would get through psychiatry training without "treating" patients against their will, whereas it is less common for psychology trainees to get this experience (though I train psychology interns in acute settings, so some programs do provide this experience). It is ethically fraught and can be distressing and frustrating working with patients who do not wish to receive treatment, and it can be hard to know when you are helping or causing harm. There is also a vocal minority who hold a special contempt for psychiatrists who do not have the same contempt for psychologists.

So while I don't wish I were a psychologist (and I have mixed feelings when I see myself described as one), I think psychiatry could learn a lot from clinical psychology. I wish there were more grounding in psychiatry residency training in social sciences, cognitive, developmental and social psychology, philosophy, critical thinking and evidence-based practice and think the field would benefit from more scholarly publications which are rare in psychiatry as compared to psychology.

What do you think about the differences between PsyD and PhD as it applies to treating patients?

I only know some of the differences: PhD more focus on scientific method and research and could go either toward research route or treating patient, PhDs tend to be paid and teach while training, PhD training in general is a bit longer.

Only in retrospect have I realized I've only seen PsyDs (and also some who had doctorates of education/counseling which I know even less about). It seems that PhDs who treat patients are much more rare.

Edit: One thing I've noticed in browsing Psychology Today is how much therapists are advertising themselves as treating WELL people without mental illness. Most of them are not doctorate level therapists. In their introductions they describe themselves more as just like a place to shoot the breeze about how crazy life gets. One wrote they had just moved to the area and can't get over how schizophrenic our weather is where I live (seemed like a red flag). It's very folksy. And then of course under specialties they list every single mental illness that has ever existed, which makes it totally useless. Even the PsyDs I see listed don't focus in their bios really on mental illness. More vague things about feeling stuck in work/life, etc. I started to wonder if the field is dumbing itself down or changing audience, or if maybe it's just the way they advertise.

 

[splik]

Edit: One thing I've noticed in browsing Psychology Today is how much therapists are advertising themselves as treating WELL people without mental illness. Most of them are not doctorate level therapists. In their introductions they describe themselves more as just like a place to shoot the breeze about how crazy life gets. One wrote they had just moved to the area and can't get over how schizophrenic our weather is where I live (seemed like a red flag). It's very folksy. And then of course under specialties they list every single mental illness that has ever existed, which makes it totally useless. Even the PsyDs I see listed don't focus in their bios really on mental illness. More vague things about feeling stuck in work/life, etc. I started to wonder if the field is dumbing itself down or changing audience, or if maybe it's just the way they advertise.

That you find this odd shows just how far psychology has strayed in recent years. It was never supposed to focus on mental illness, and psychotherapy was not really meant to be a treatment for mental illness. American clinical psychology has, to its detriment, wholeheartedly aligned itself with the biomedical/psychiatric approach which privileges diagnosis and treatment of psychopathology. Most clinical psychologists seem to be very comfortable with their patients receiving psychotropic medications and some routinely stray from their scope of practice to recommending specific medications to patients. By contrast British psychology rejected this approach wholesale - most British clinical psychologists are decidedly anti-diagnosis, anti-medication, and anti-psychiatry.

Ironically, the main reason that American psychiatry embraced the neo-Kraepelinian diagnostic approach to psychiatry that privileged diagnoses was in order to compete with psychologists and other therapists. For much of the 20th century you had to be an MD to provide psychoanalysis and psychotherapy was firmly in the province of psychiatry (it wasn't until the 1990s that the psychologists won their anti-trust suit against the American Psychoanalytic Association that had barred them from membership. While psychoanalysts in the rest of the world were mostly laypersons, American Psychiatry had ignored Freud's views and with some notable exceptions, limited psychoanalysis to the medical profession). By the 1970s psychiatry had lost its moral authority over morbid mental states and a whole array of therapies and therapists were proliferating who sought to provide psychotherapy as a balm for the masses much more cheaply than psychiatrists. In order to reassert their moral authority and corner of the market share, psychiatrists embraced their physician identity. What separate physicians was the ability to diagnose and prescribe medications. And thus from the 1980s diagnostic psychiatry, biological psychiatry, and psychopharmacology were in the ascendance. Prior to this many psychiatrists considered diagnosis irrelevant, and dynamic psychiatry considered the boundaries between mental health and illness to be fluid. Similarly, with the exception of neuroleptics, most American psychiatrists viewed medications (e.g. benzos, TCAs, MAOIs) with suspicion. If you look at ads from that time, the pharmaceutical companies clearly marketed these medications within a psychodynamic formulation as a way to help facilitate psychotherapy, and NOT (as is often claimed today) to treat underlying biological abnormalities or specific mental disorders.

David Barlow, who is a prominent psychologist in the CBT tradition, has argued that the term psychotherapy should be reserved for the use of psychological approaches for personal growth, and the term psychological treatment used when using psychotherapy to treat mental disorders. There is nothing inherent about CBT for example that limits itself to use for psychopathology, and many other psychotherapies are probably most helpful for problems of living than diagnostic categories. One can only conclude that American psychologists cynically followed their psychiatric colleagues down this particular path for pecuniary gain. Once the field was flooded with an increasing diverse array of different kinds of therapists (some "therapists" in the loosest sense), many needed to accept insurance for survival, which meant working with mental disorder and using diagnostic entities. Those who are cash pay are unencumbered from this and can cater to those seeking personal and professional growth, or other problems of living without subscribing to a pathological model that runs contrary to the field as a whole.

 

[birchswing]

That you find this odd shows just how far psychology has strayed in recent years. It was never supposed to focus on mental illness, and psychotherapy was not really meant to be a treatment for mental illness. American clinical psychology has, to its detriment, wholeheartedly aligned itself with the biomedical/psychiatric approach which privileges diagnosis and treatment of psychopathology. Most clinical psychologists seem to be very comfortable with their patients receiving psychotropic medications and some routinely stray from their scope of practice to recommending specific medications to patients. By contrast British psychology rejected this approach wholesale - most British clinical psychologists are decidedly anti-diagnosis, anti-medication, and anti-psychiatry.

Ironically, the main reason that American psychiatry embraced the neo-Kraepelinian diagnostic approach to psychiatry that privileged diagnoses was in order to compete with psychologists and other therapists. For much of the 20th century you had to be an MD to provide psychoanalysis and psychotherapy was firmly in the province of psychiatry (it wasn't until the 1990s that the psychologists won their anti-trust suit against the American Psychoanalytic Association that had barred them from membership. While psychoanalysts in the rest of the world were mostly laypersons, American Psychiatry had ignored Freud's views and with some notable exceptions, limited psychoanalysis to the medical profession). By the 1970s psychiatry had lost its moral authority over morbid mental states and a whole array of therapies and therapists were proliferating who sought to provide psychotherapy as a balm for the masses much more cheaply than psychiatrists. In order to reassert their moral authority and corner of the market share, psychiatrists embraced their physician identity. What separate physicians was the ability to diagnose and prescribe medications. And thus from the 1980s diagnostic psychiatry, biological psychiatry, and psychopharmacology were in the ascendance. Prior to this many psychiatrists considered diagnosis irrelevant, and dynamic psychiatry considered the boundaries between mental health and illness to be fluid. Similarly, with the exception of neuroleptics, most American psychiatrists viewed medications (e.g. benzos, TCAs, MAOIs) with suspicion. If you look at ads from that time, the pharmaceutical companies clearly marketed these medications within a psychodynamic formulation as a way to help facilitate psychotherapy, and NOT (as is often claimed today) to treat underlying biological abnormalities or specific mental disorders.

David Barlow, who is a prominent psychologist in the CBT tradition, has argued that the term psychotherapy should be reserved for the use of psychological approaches for personal growth, and the term psychological treatment used when using psychotherapy to treat mental disorders. There is nothing inherent about CBT for example that limits itself to use for psychopathology, and many other psychotherapies are probably most helpful for problems of living than diagnostic categories. One can only conclude that American psychologists cynically followed their psychiatric colleagues down this particular path for pecuniary gain. Once the field was flooded with an increasing diverse array of different kinds of therapists (some "therapists" in the loosest sense), many needed to accept insurance for survival, which meant working with mental disorder and using diagnostic entities. Those who are cash pay are unencumbered from this and can cater to those seeking personal and professional growth, or other problems of living without subscribing to a pathological model that runs contrary to the field as a whole.

Utterly fascinating. Thank you for this!

 

[WisNeuro]

What do you think about the differences between PsyD and PhD as it applies to treating patients?

I only know some of the differences: PhD more focus on scientific method and research and could go either toward research route or treating patient, PhDs tend to be paid and teach while training, PhD training in general is a bit longer.

Only in retrospect have I realized I've only seen PsyDs (and also some who had doctorates of education/counseling which I know even less about). It seems that PhDs who treat patients are much more rare.

Edit: One thing I've noticed in browsing Psychology Today is how much therapists are advertising themselves as treating WELL people without mental illness. Most of them are not doctorate level therapists. In their introductions they describe themselves more as just like a place to shoot the breeze about how crazy life gets. One wrote they had just moved to the area and can't get over how schizophrenic our weather is where I live (seemed like a red flag). It's very folksy. And then of course under specialties they list every single mental illness that has ever existed, which makes it totally useless. Even the PsyDs I see listed don't focus in their bios really on mental illness. More vague things about feeling stuck in work/life, etc. I started to wonder if the field is dumbing itself down or changing audience, or if maybe it's just the way they advertise.

This may just be your immediate area, or you're just not seeing it, the vast majority of PhDs are clinicians. Only a very small percentage are going for predominantly research careers.

 

[TexasPhysician]

Hello! I am a psychology student currently debating grad and medical school. I am wondering if anyone here thinks they would have been happier, more impactful, more fulfilled, etc., if they had gone through a PhD psychology program instead, mainly in terms of patient care than anything related to research. Also, if any psychologists wander in I'd love to hear their thoughts on the reverse of this question.

Extraneous information: I know its hard to measure these "what-ifs" but I'm curious if it elicits any specific thoughts or if I shouldn't worry about it at all. I have encountered numerous threads in my internet poking in which therapists and even a few psychologists regret their decision in favor of medicine for reasons relating to pay, job security, and schooling. As of yet I don't think I've read anything inversed. Of course, I'm sure many of those people haven't fully grasped how damn hard the medical path is. Also, a big thanks to everyone who has previously responded thus far to my questions. I hope y'all don't mind if I pop in every now and then as I continue to figure things out.

Thanks!

Private practice psychologists can make good money. Nothing wrong with going that route.

When I was in college, I found psychology to be the more interesting classes but exposure to the profession was low. It is a dedicated path, so you need to be sure it’s for you. I was set on medical school and going into emergency medicine. It wasn’t until MS3 that I discovered my new path of psychiatry. I found the depth of med school stimulating. If not psychiatry, I would have chosen another medical specialty. I appreciate how medicine all weaves together.

Psychology PhD isn’t for me, but if it calls you, there is nothing wrong with going that route.

 

[WisNeuro]

Private practice psychologists can make good money. Nothing wrong with going that route.

When I was in college, I found psychology to be the more interesting classes but exposure to the profession was low. It is a dedicated path, so you need to be sure it’s for you. I was set on medical school and going into emergency medicine. It wasn’t until MS3 that I discovered my new path of psychiatry. I found the depth of med school stimulating. If not psychiatry, I would have chosen another medical specialty. I appreciate how medicine all weaves together.

Psychology PhD isn’t for me, but if it calls you, there is nothing wrong with going that route.

At least IME the graduate level coursework was so much more interesting, the undergrad coursework tends to be pretty surface level aside from possibly some honors classes with lower enrollment.

 

[brazilianpsych]

As for competition for psych residencies - between 1 in 5 and 1 in 6 psychiatrists residents is an IMG. IMGs are appointed for positions which there are no comparably qualified US medical students or graduates. While psychiatry is not anywhere near as easy to match into as in the 90s or early 2000s, it is not a competitive specialty. It is just more competitive than it used to be. The vast majority of medical students have no interest in psychiatry whatsoever. This is not likely to change. What is changing is there are more medical students and they are more likely to be attracted to specialties that have a better work-life balance than was the case in the past.

Loved your posts, but just wanted to make a point about the data (just checked it): it is 15.6% of IMGs at Psych, however, some of those are US IMGs (like Caribbeans). The rate of Non-US IMG is around 7%. Just thought of pointing that out. Psych is def not insanely competitive but I think it is getting worse every year.

Got it from the official NRMP data: SAP Crystal Reports - (kinstacdn.com)

 

[heartsink]

Fascinating! This is pretty much in line with my own thinking. I've loved studying psychology, but think I'd like to limit further informal study to only clinically relevant information. I feel like I'd be bored to tears learning about anything that wasn't or about extremely specific things, which is my understanding of PhDs. I have no great questions really, just wanna wade in and care for some people.

This is a very salient point - be sure you can least tolerate all of clinical medicine and not just psychiatry, or you will be bored to tears long before you reach residency and might burn out.

 

[WisNeuro]

This is a very salient point - be sure you can least tolerate all of clinical medicine and not just psychiatry, or you will be bored to tears long before you reach residency and might burn out.

Also, much of what people consider "not clinically relevant" actually is very clinically relevant. Or at least clinically relevant to being a good clinician. Stats as they relate to clinical interventions comes to mind. Most doctoral level providers are woefully lacking in this knowledge.

 

[psychacad]

Loved your posts, but just wanted to make a point about the data (just checked it): it is 15.6% of IMGs at Psych, however, some of those are US IMGs (like Caribbeans). The rate of Non-US IMG is around 7%. Just thought of pointing that out. Psych is def not insanely competitive but I think it is getting worse every year.

Got it from the official NRMP data: SAP Crystal Reports - (kinstacdn.com)

Psychiatry is definitely getting up there in terms of competitiveness, almost on par now with EM and Anesthesiology (based on % MD seniors - there is probably a lot of self-selection there but still).

 

[erg923]

One could also look at this in terms off how much do you really want to "take care of people?"

A person can be very interested and invested in something (or a topic) but not necessarily want to "take care of" said persons all the live long day or assume any kind of liability...treatment or otherwise.

For example, I loved/love investigating Schizophrenia, as well as other forms of related psychopathology. And I pursued a Ph.D. in "Clinical Psychology" for a reason, but vocationally, I have very little interest in the actual day-to-day realties of treating this population...as that is not really what interests me. And I have little to no interest in psychopharmacology.

Said the Academic Clinical Psychologist....who is no longer even in academia.

 

[MustIReallyThough]

Private practice psychologists can make good money. Nothing wrong with going that route.

When I was in college, I found psychology to be the more interesting classes but exposure to the profession was low. It is a dedicated path, so you need to be sure it’s for you. I was set on medical school and going into emergency medicine. It wasn’t until MS3 that I discovered my new path of psychiatry. I found the depth of med school stimulating. If not psychiatry, I would have chosen another medical specialty. I appreciate how medicine all weaves together.

Psychology PhD isn’t for me, but if it calls you, there is nothing wrong with going that route.

Why would you say it isn't for you?

I'm leaning away from it, but I want to be sure its for the right reasons. Since both end results do seem great I'm mainly comparing the schooling and would see myself more engaged as a med student on rotations than a scientist.

 

[MustIReallyThough]

This is a very salient point - be sure you can least tolerate all of clinical medicine and not just psychiatry, or you will be bored to tears long before you reach residency and might burn out.

Also, much of what people consider "not clinically relevant" actually is very clinically relevant. Or at least clinically relevant to being a good clinician. Stats as they relate to clinical interventions comes to mind. Most doctoral level providers are woefully lacking in this knowledge.

Great points! I guess you never know when something might randomly become relevant. I'll stay open

 

[MustIReallyThough]

One could also look at this in terms off how much do you really want to "take care of people." Right?
A person can be very interested and invested in something (or a topic) but not necessarily want to "take care of" said persons all the live long day or assume any kind of liability...treatment or otherwise.

For example, I loved/love investigating Schizophrenia, as well as other forms of related psychopathology. And I pursued a Ph.D. in "Clinical Psychology" for a reason, but vocationally, I have very little interest in the day-to-day realties of treating this population...as that is not really what interests me. And I have little to no interest in psychopharmacology.

Said the Academic Clinical Psychologist....who is no longer even in academia.

With such inexperience its hard to say with certainty, but I've always wanted to be the clinician that answers calls and handles crisis. I guess this desire will dampen in time once I'm exposed to harsh realities, but I don't think it would ever fade completely. Its a huge honor to be the one whom help is asked of and I'd hope I'd have the empathy and patience to really reach some people. And I do still envision that at 2 am after a grueling shift, maybe especially. Its all I've ever wanted to do.

Everyone...does that sound more like a psychologist or psychiatrist? It's my understanding that physicians see more call, and possibly more SMI in general, but I'm not sure.