Do you regret not pursuing psychology?

[WisNeuro]

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.

Wholly dependent on setting and your job. You can have this in either profession if you want.

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[erg923]

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.

This would, undoubtedly, be a physician's mentality. I don't know that I would say "heart" though. Seems like it would get old after a while? And never met anyone that wants "more call'...if that helps you?

Personally, I have a desire to do NO such thing. But we like mostly the same stuff. Make sense?

 

[MustIReallyThough]

This would, undoubtedly, be a physician's mentality. I don't know that I would say "heart" though. Seems like it would get old after a while? And never met anyone that wants "more call'...if that helps you?

Personally, I have a desire to do NO such thing. But we like mostly the same stuff. Make sense?

Probably ^^ curious how the others feel about it. I might also run for the hills after my youthful bubble of exuberance is burst, but that is the goal. I want to have as big as impact as I can and taking a lot of call would lend itself to that

 

[Stagg737]

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.

If you go to a USMD (or even DO) school then you should be fine as long as you don't have too many red flags and are reasonable about your application. It is becoming more popular and is a bit more difficult than in the past, but I would still not consider it a competitive field by any means and most US grads can match without significant problems.

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.

Transitional year is essentially an intern year for people who do not match into a specialty. It's a way to show you're still working on furthering your education even without matching to a specialty. For transitional programs, you're essentially going through the match a second time, though some people may be able to find a position that takes them as a PGY-2 or 1 without having to go through the match. Some fields require a pre-lim year (psychiatry does not), which essentially means you matched and are completing a traditional intern year before starting rotations specific to your field. You could always try and transfer into a psych residency from here or go through the match again to try and match as a PGY-2 (some programs hold PGY-2 positions).

The general rule of thumb is that every time you go through the match it gets harder to match (with rare exceptions). Obviously, it's easiest to just match into psych, but if you don't it does not mean you're barred from the field.

 

[MustIReallyThough]

If you go to a USMD (or even DO) school then you should be fine as long as you don't have too many red flags and are reasonable about your application. It is becoming more popular and is a bit more difficult than in the past, but I would still not consider it a competitive field by any means and most US grads can match without significant problems.



Transitional year is essentially an intern year for people who do not match into a specialty. It's a way to show you're still working on furthering your education even without matching to a specialty. For transitional programs, you're essentially going through the match a second time, though some people may be able to find a position that takes them as a PGY-2 or 1 without having to go through the match. Some fields require a pre-lim year (psychiatry does not), which essentially means you matched and are completing a traditional intern year before starting rotations specific to your field. You could always try and transfer into a psych residency from here or go through the match again to try and match as a PGY-2 (some programs hold PGY-2 positions).

The general rule of thumb is that every time you go through the match it gets harder to match (with rare exceptions). Obviously, it's easiest to just match into psych, but if you don't it does not mean you're barred from the field.

So DO wouldn't be a big deal for psych? I'm non trad af so could possibly end up with that route.

Thanks for the quality information! I'm still learning things about the pre-med world, but inching towards a full picture.

 

[singasongofjoy]

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

I think I would have enjoyed psychiatry, at least in the positions of the psychiatrists I have worked with within the clinics I work/trained in. but probably not any more than I enjoy what I do now, and I doubt I would have survived med school and residency. Both paths are very intense but demanding in somewhat different ways. E.g., at my (unusually intense program that I intensified myself by committing to get out of there a year early) I worked/studied/etc 80-90 hour weeks regularly... BUT- I don't sleep all that well generally, and with PhD I didn't have to **** up my circadian rhythm and I never pulled an all-nighter. and I still don't have to do that in job, (for the most part- COVID has created some exceptions), I graduated with no debt, and have a partner who is also reasonably frugal and financially savvy who makes a bit more than me, so I don't have any financial worries and we've got plenty left over even after retirement, daycare, mortgage and college funds. so no, even though I would have enjoyed psychiatry I think, if I ended up working with the same population, I don't regret it at all because the training and working my way up to a more family/parent friendly position and environment would have broken me and probably also my marriage.

All that to say - I think it's good to know yourself well and what you can and can't handle with respect to the day to day of both trainign and the likely job. Some folks thrive on what would do other people in and vice versa.

 

[nexus73]

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.

As mentioned above this is a psychiatrist's role more than a psychologist. But if you become a psychiatrist, you're not forever bound to a high stress, crisis job (ED, inpatient, medical consults). If you get tired of the intensity, there's no shortage of more relaxed and predictable outpatient work doing medications and therapy.

 

[phonyreal98]

So I can speak a bit to both sides I think- I am an MD/PhD; my area of expertise is cognitive neuroscience and my PhD advisor was originally trained as a developmental psychologist. My PhD probably looked more like a cognitive psychology or developmental psychology PhD than even a neuroscience PhD in cellular/molecular areas of neuroscience. If I had it to do over again I'd probably still do the MD/PhD. But if you forced me to choose between an MD or a PhD in psychology I would probably do a PhD in psychology. I'm finding that the clinician-scholar angle very similar to how I approach things. Also I personally still like research (and all the things that come with it- writing grants, etc) more than I personally like medicine.

 

[Sushirolls]

Also I personally still like research (and all the things that come with it- writing grants, etc) more than I personally like medicine.

This is also something to consider. Medicine is heavily a service industry and requires frequent people contact. With time, the tolerability for being in a service industry wanes for some people. They seek an exit or an out to have less contact with people, or more of a desk job. Be aware of this.

 

[MustIReallyThough]

I think I would have enjoyed psychiatry, at least in the positions of the psychiatrists I have worked with within the clinics I work/trained in. but probably not any more than I enjoy what I do now, and I doubt I would have survived med school and residency. Both paths are very intense but demanding in somewhat different ways. E.g., at my (unusually intense program that I intensified myself by committing to get out of there a year early) I worked/studied/etc 80-90 hour weeks regularly... BUT- I don't sleep all that well generally, and with PhD I didn't have to **** up my circadian rhythm and I never pulled an all-nighter. and I still don't have to do that in job, (for the most part- COVID has created some exceptions), I graduated with no debt, and have a partner who is also reasonably frugal and financially savvy who makes a bit more than me, so I don't have any financial worries and we've got plenty left over even after retirement, daycare, mortgage and college funds. so no, even though I would have enjoyed psychiatry I think, if I ended up working with the same population, I don't regret it at all because the training and working my way up to a more family/parent friendly position and environment would have broken me and probably also my marriage.

All that to say - I think it's good to know yourself well and what you can and can't handle with respect to the day to day of both trainign and the likely job. Some folks thrive on what would do other people in and vice versa.

Can you expand more on the particulars in how the training differs? As I understand it psychiatry residencies aren't often soul crushing and average about 50 hours a week besides intern year. Or are you comparing the "slow burn" of dissertation to the variable call hours and longer shifts of psychiatry?

Thanks a bunch for that, you sound like you know both sides pretty well. I'd love to talk more about your thoughts if you're down, especially about research.

 

[MustIReallyThough]

So I can speak a bit to both sides I think- I am an MD/PhD; my area of expertise is cognitive neuroscience and my PhD advisor was originally trained as a developmental psychologist. My PhD probably looked more like a cognitive psychology or developmental psychology PhD than even a neuroscience PhD in cellular/molecular areas of neuroscience. If I had it to do over again I'd probably still do the MD/PhD. But if you forced me to choose between an MD or a PhD in psychology I would probably do a PhD in psychology. I'm finding that the clinician-scholar angle very similar to how I approach things. Also I personally still like research (and all the things that come with it- writing grants, etc) more than I personally like medicine.

Would you be comfortable sharing the particulars of how you reached this understanding? I'm assuming there was a moment where you realized you preferred x. Like was it the more introverted style of reading and writing papers you preferred or something specific about clinical practice you did not prefer?

Thanks for the diverse group of responses! It's definitely a huge consideration now, research vs practice that is. I'm pretty damn introverted, so I should be open to research more than I currently am I think. At least I can through the masters counseling idea clean out the window. That just wouldn't work, and of course its the one path I pursued as a younger and dumber undergrad. Ya learn things.

 

[MustIReallyThough]

This is also something to consider. Medicine is heavily a service industry and requires frequent people contact. With time, the tolerability for being in a service industry wanes for some people. They seek an exit or an out to have less contact with people, or more of a desk job. Be aware of this.

Still, wouldn't I be able to get involved in research with an MD if I really needed to do so? Or is there always some clinical practice involved that is not the same in psychology research?

I've been thinking about this and what nexus mentioned about call. I can only assume call is rougher than I could possibly imagine if no one wants to do it (insane hours, drug induced psychosis, combativeness?). Also that I'm pretty introverted, so I definitely should consider that clinical practice might sink my battleship. A lot of things to think about.

 

[Stagg737]

Still, wouldn't I be able to get involved in research with an MD if I really needed to do so? Or is there always some clinical practice involved that is not the same in psychology research?

I've been thinking about this and what nexus mentioned about call. I can only assume call is rougher than I could possibly imagine if no one wants to do it (insane hours, drug induced psychosis, combativeness?). Also that I'm pretty introverted, so I definitely should consider that clinical practice might sink my battleship. A lot of things to think about.

It is possible to do only research with no clinical time as a physician.

 

[MustIReallyThough]

This is your second thread related to this topic. Perhaps it would be wise to invest your time into shadowing both a psychiatrist and a psychologist to see what floats your boat. Checking out the differences between grad programs and medical school would also be a great start. Competitiveness and rigor of coursework is night and day, speaking as someone who has done both.

If you make this life decision based on what strangers on the internet tell you, you’re going to be in for a rough ride. Get out there and gain experiences. It’s usually not tough for someone to decide between the two. It comes down to being a physician vs not being a physician.

What do you think is the best way to go about gaining shadowing opportunities?

Definitely in the works though, in contact with a few folks I cold emailed through my uni. Overall I'm just trying to gain as many perspectives as possible and will review this going forward in tandem with shadowing.

 

[phonyreal98]

It is possible to do only research with no clinical time as a physician.

Possible but you will need to put in the time at some point to train as a researcher if you are going to be paid primarily to be a researcher. Whether that's a PhD, research track residency, and/or postdoc is an individual decision. The skills needed to be a full-time researcher just are not part of the medical school curriculum (or part of the standard psychiatry residency curriculum/experiences that all psychiatry residents are required to have).

 

[phonyreal98]

Would you be comfortable sharing the particulars of how you reached this understanding? I'm assuming there was a moment where you realized you preferred x. Like was it the more introverted style of reading and writing papers you preferred or something specific about clinical practice you did not prefer?

Thanks for the diverse group of responses! It's definitely a huge consideration now, research vs practice that is. I'm pretty damn introverted, so I should be open to research more than I currently am I think. At least I can through the masters counseling idea clean out the window. That just wouldn't work, and of course its the one path I pursued as a younger and dumber undergrad. Ya learn things.

First year of graduate school. As soon as I got started in graduate school I knew I immediately felt more comfortable with doing "graduate school things" (for me, this means writing fellowships, writing papers, analyzing data, coding, designing fMRI tasks, making presentations) than I was with doing "medical school things." When I went back to M3 I tried to take the advice from the MD/PhD students who came before me and to "leave the lab behind" and I just couldn't do it.

 

[MustIReallyThough]

First year of graduate school. As soon as I got started in graduate school I knew I immediately felt more comfortable with doing "graduate school things" (for me, this means writing fellowships, writing papers, analyzing data, coding, designing fMRI tasks, making presentations) than I was with doing "medical school things." When I went back to M3 I tried to take the advice from the MD/PhD students who came before me and to "leave the lab behind" and I just couldn't do it.

Ah ok, so I'm assuming you went for the MD/PhD track from the start and didn't transfer or anything.

I'll definitely keep that in mind. I want to work as a RA for awhile before I make decisions, so with shadowing as well I hope that will be enough to see. None of what you mentioned interests me but I bet I'll be surprised.

By the way, did you have interest in research in undergrad?

 

[Merovinge]

It is possible to do only research with no clinical time as a physician.

Absolutely, one of the most prestigious docs at my residency was like this. He technically took 2 call weekends a month ,to remain a practicing doc, but it would have been a travesty if not for residents on.

 

[Attending1985]

Sometimes. I like being an md but I love doing therapy and in the current environment it’s not a skill we are valued for or encouraged to use.

 

[singasongofjoy]

Can you expand more on the particulars in how the training differs? As I understand it psychiatry residencies aren't often soul crushing and average about 50 hours a week besides intern year. Or are you comparing the "slow burn" of dissertation to the variable call hours and longer shifts of psychiatry?

Thanks a bunch for that, you sound like you know both sides pretty well. I'd love to talk more about your thoughts if you're down, especially about research.

Remember that for years before you'd start a psychiatry residence you'd be working towards being MD first and foremost, with all the components of getting through medical school and all of those varied rotations. THAT is the part I was sure would do me in and that you should consider more in detail. I know there are laws/rules about how many hours/shifts students can work in a row / per week, but the actuality relayed by my friends who went through med school still involved a lot of long stretches without sleep. If you like the adrenaline rushes of being on call etc, medicine/psychiatry might be a better fit as the rewards in psychology tend to unfold over a longer stretch most of the time- more of a "slow burn" as you described - both in the positives and the negative aspects of the profession and training- IME anyway.

 

[Stagg737]

Possible but you will need to put in the time at some point to train as a researcher if you are going to be paid primarily to be a researcher. Whether that's a PhD, research track residency, and/or postdoc is an individual decision. The skills needed to be a full-time researcher just are not part of the medical school curriculum (or part of the standard psychiatry residency curriculum/experiences that all psychiatry residents are required to have).

True, and I'd imagine that most physicians who are only doing research that aren't MD/PhD did clinical work at some point post-residency before transitioning to FT research. It is possible though, although I also agree that unfortunately most med schools do not provide adequate general curricula in terms of statistics and general research skills to build a career around this.

Remember that for years before you'd start a psychiatry residence you'd be working towards being MD first and foremost, with all the components of getting through medical school and all of those varied rotations. THAT is the part I was sure would do me in and that you should consider more in detail. I know there are laws/rules about how many hours/shifts students can work in a row / per week, but the actuality relayed by my friends who went through med school still involved a lot of long stretches without sleep. If you like the adrenaline rushes of being on call etc, medicine/psychiatry might be a better fit as the rewards in psychology tend to unfold over a longer stretch most of the time- more of a "slow burn" as you described - both in the positives and the negative aspects of the profession and training- IME anyway.

To be fair, many med students don't actually take real call. The only rotations I had "call" on were surgery and OB/gyn. For OB/gyn we were told we'd be called in if there was a really interesting case (twins, placenta previa/accretia, etc) which never happened. I got called in once out of ~15 call days on my 8 weeks of surgery on a Sunday morning for an "emergent" cholecystectomy. The hours can be long, but I'd be shocked if most med students ever experience real call like they do in residency.

 

[singasongofjoy]

True, and I'd imagine that most physicians who are only doing research that aren't MD/PhD did clinical work at some point post-residency before transitioning to FT research. It is possible though, although I also agree that unfortunately most med schools do not provide adequate general curricula in terms of statistics and general research skills to build a career around this.



To be fair, many med students don't actually take real call. The only rotations I had "call" on were surgery and OB/gyn. For OB/gyn we were told we'd be called in if there was a really interesting case (twins, placenta previa/accretia, etc) which never happened. I got called in once out of ~15 call days on my 8 weeks of surgery on a Sunday morning for an "emergent" cholecystectomy. The hours can be long, but I'd be shocked if most med students ever experience real call like they do in residency.

Thanks for the clarification - I may be conflating the student and residency years as I obviously have no first-hand experience going through that process.

 

[the_blackest_night]

Nope... I truly enjoy being able to provide psychotherapy AND prescribe medications. I've never met a psychiatrist who wish they became a psychologist. But I've spoken to psychologists who seem to wish they went to med school.

 

[MustIReallyThough]

be a better fit as the rewards in psychology tend to unfold over a longer stretch most of the time- more of a "slow burn" as you described - both in the positives and the negative aspects of the profession and training- IME anyway.

Could you share some of what you experienced as positives and negatives? Also curious about your thoughts on research. Thanks for dropping in!

 

[MustIReallyThough]

Sometimes. I like being an md but I love doing therapy and in the current environment it’s not a skill we are valued for or encouraged to use.

Do you have any plans to focus on therapy later in your career? Private practice maybe?

 

[MustIReallyThough]

Nope... I truly enjoy being able to provide psychotherapy AND prescribe medications. I've never met a psychiatrist who wish they became a psychologist. But I've spoken to psychologists who seem to wish they went to med school.

Same, so tried to explore that a bit. What has your experience been with therapy?

 

[TheaterOfTheme]

I was sort of in between deciding on doing psychology or medical school--but it was more that my interest in psychology led me to my interest in the hard sciences during undergrad. Then when I started considering med school vs PhD, I realized psychiatry would be an amazing field. There were times in the preclinical years I wished I wasn't in medical school and there are times on medicine rotations I wish that as well. HOWEVER, even though I do not enjoy clinical medicine, I find it invaluable to have obtained such a broad understanding of human disease and I honestly prefer knowing more rather than less. Psychiatry is an amazingly malleable field and I would never consider going back and choosing psychology at this point. I too, am very interested in therapy, so I am ranking programs with more therapy in their curriculum. I think psychiatry is this perfect niche for my personality, and its an amazing feeling to have found something like that.

Good luck in your decision. Also, I'm a DO student, which does definitely close some doors, but more doors are open than I thought would be. When it comes down to it, the top 20 programs are all about in-breading and there are also quite a few of mid-level programs that will never consider a DO, but the large majority do! Heck, even a couple top places consider DOs! The increasing number of medical grads is a cause for concern, though--go MD if you can!

 

[singasongofjoy]

The increasing number of medical grads is a cause for concern, though--go MD if you can!

Do you (or any other med folks out there) think that COVID will affect the number of people pursuing medicine? and if so, curious to hear your reasoning.

 

[hallowmann]

Absolutely, one of the most prestigious docs at my residency was like this. He technically took 2 call weekends a month ,to remain a practicing doc, but it would have been a travesty if not for residents on.

This was way too close to home, had flashbacks to 1st and 2nd year.

Nope... I truly enjoy being able to provide psychotherapy AND prescribe medications. I've never met a psychiatrist who wish they became a psychologist. But I've spoken to psychologists who seem to wish they went to med school.

Honestly, I think that's because they haven't been through med school and residency. I really wonder how many would say the same thing if they had to actually experience it.

Do you (or any other med folks out there) think that COVID will affect the number of people pursuing medicine? and if so, curious to hear your reasoning.

It probably will. In times of economic downturn, many people return to school/training and to more stable jobs. Healthcare offers quite a few stable jobs despite exposure risk. It happened in 2008-2012, it'll happen 2020-2024 probably as well, but I wouldn't be surprised if the ease of getting into an online NP program that boasts close to "100% acceptance rates" after an accelerated BSN (3-4 yrs total) might pull people out of it the MD/DO track.

 

[Ole_Toe]

This was way too close to home, had flashbacks to 1st and 2nd year.


Honestly, I think that's because they haven't been through med school and residency. I really wonder how many would say the same thing if they had to actually experience it.


It probably will. In times of economic downturn, many people return to school/training and to more stable jobs. Healthcare offers quite a few stable jobs despite exposure risk. It happened in 2008-2012, it'll happen 2020-2024 probably as well, but I wouldn't be surprised if the ease of getting into an online NP program that boasts close to "100% acceptance rates" after an accelerated BSN (3-4 yrs total) might pull people out of it the MD/DO track.

I can see the current landscape drawing more people to APRN degree mills than to medical school. Don't forget that medical school applications are very expensive and take at least of few years of preparation. It's far too soon to tell if the COVID pandemic will attract more people to pursue medical school.

 

[TheaterOfTheme]

Do you (or any other med folks out there) think that COVID will affect the number of people pursuing medicine? and if so, curious to hear your reasoning.

I heard there was a 15-20% increase in applicants to med school this year from a friend who is applying. As stated above, low economic times lead to increased applicants. However, the problem I'm referring to is on the tail end of med school--that is, trying to get into residency. Since more schools are opening up, that makes competition fiercer for every specialty. Of course we need more doctors, but opening med schools isn't the solution (as stated many times all over SDN).

 

[singasongofjoy]

I heard there was a 15-20% increase in applicants to med school this year from a friend who is applying. As stated above, low economic times lead to increased applicants. However, the problem I'm referring to is on the tail end of med school--that is, trying to get into residency. Since more schools are opening up, that makes competition fiercer for every specialty. Of course we need more doctors, but opening med schools isn't the solution (as stated many times all over SDN).

Yeah, similar problem in psych a while back with internship placements at the end of training though not nearly as bad as it was a few year ago. But the influx of for-profit schools churning out students floods the market- though mostly to their disadvantage and disappointment. I was wondering if folks might be more or less motivated for medicine over other options in the light of the madhouse things are with COVID right now. Being adjacent to it certainly reaffirms my decision that psychologist is the much better fit for me. It's hard enough being a psychologist ight now (part of an AMC).

 

[Mad Jack]

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?

Well the problem you'll run into if you want to do psychiatry is that if you don't match you'll probably be miserable. If I didn't match psych there is a good chance I would have given up on medicine entirely

 

[TheaterOfTheme]

Well the problem you'll run into if you want to do psychiatry is that if you don't match you'll probably be miserable. If I didn't match psych there is a good chance I would have given up on medicine entirely

Your a PGY4 now right? I remember you dual applied FM or IM back in the day if I'm not mistaken.

 

[Mad Jack]

Your a PGY4 now right? I remember you dual applied FM or IM back in the day if I'm not mistaken.

I try not to divulge too much, but that's close. I dual applied at the time and ended up not ranking any of the IM programs I interviewed at because just the idea of doing IM made my stomach turn

 

[MaximusMDPhD]

I do regret it, yes. There's a lot of allopathic hospital-based beatitudes that I'm eager to shed entirely. The "knowing" is perhaps most exhausting. I often feel like I'm sacrificing wisdom for knowledge by going this route but I'll know on the other side if it was worth the pay raise.

 

[MustIReallyThough]

I do regret it, yes. There's a lot of allopathic hospital-based beatitudes that I'm eager to shed entirely. The "knowing" is perhaps most exhausting. I often feel like I'm sacrificing wisdom for knowledge by going this route but I'll know on the other side if it was worth the pay raise.

Man, they must be some kind of beatitudes. Would you say you're more research oriented then? Like after the cutting edge of psychology research instead of seeing patients? Or just dem beatitudes. Please do tell all, pm me if you like!

 

[Attending1985]

I do regret it, yes. There's a lot of allopathic hospital-based beatitudes that I'm eager to shed entirely. The "knowing" is perhaps most exhausting. I often feel like I'm sacrificing wisdom for knowledge by going this route but I'll know on the other side if it was worth the pay raise.

Can you expound of this?

 

[Attending1985]

Do you have any plans to focus on therapy later in your career? Private practice maybe?

Not sure I need the benefits of an employed position

 

[mentalhealthnut]

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

Do you think that as a physician that your opportunities to provide therapy are as abundant as you would like? I am starting to notice that many psychiatrists are ONLY offering medication mangement. I am also a psych undergrad student and I am also considering medical school. I would NOT be interested in medical school if that meant that (as a psychiatrist) I visited with my patients for only 15 minutes for their medication and provided NO therapy. Therapy is important to me, but so is medication. I want to be able to do both.

 

[Attending1985]

Do you think that as a physician that your opportunities to provide therapy are as abundant as you would like? I am starting to notice that many psychiatrists are ONLY offering medication mangement. I am also a psych undergrad student and I am also considering medical school. I would NOT be interested in medical school if that meant that (as a psychiatrist) I visited with my patients for only 15 minutes for their medication and provided NO therapy. Therapy is important to me, but so is medication. I want to be able to do both.

opportunities are nowhere near abundant for this type of work. Employers are interested in production and not interested in you providing therapy.

 

[romanticscience]

Do you think that as a physician that your opportunities to provide therapy are as abundant as you would like? I am starting to notice that many psychiatrists are ONLY offering medication mangement. I am also a psych undergrad student and I am also considering medical school. I would NOT be interested in medical school if that meant that (as a psychiatrist) I visited with my patients for only 15 minutes for their medication and provided NO therapy. Therapy is important to me, but so is medication. I want to be able to do both.

Consider practicing what you’re best at. I’d say “at top of your license” but I hate that phrase. Basically, your greatest value in the mental health treated hierarchy.

Your residency training experience will likely give you way more experience with medical evaluation and management (prescribing), compared to psychotherapy. Also, the types of therapies you’ll learn as part of the basic competency standards will be only applicable to good prognosis/easy/mild cases (ie, basic CBT and IPT). IMO, these people tend to get well with a PCP or counselor before seeing a psychiatrist. Many people looking for treatment in the community are complex/“difficult”/borderline—personality impaired. Those types of cases and therapeutic techniques, unless you arrange them yourself, are not experiences which are part of most residency curricula. Yes, you’ll get a PowerPoint on DBT but you won’t have near as many cases with good related supervision.

So, without advanced psychotherapy training, you are more suited and comfortable to treat things, even complex cases, with somatic therapy.

Also, consider that “good” doctoring is very therapeutic but doesn’t have to be “therapy.” A solid, empathic, 30-min encounter every month is sometimes more fulfilling that weekly hours of interpreting.

 

[TexasPhysician]

Do you think that as a physician that your opportunities to provide therapy are as abundant as you would like? I am starting to notice that many psychiatrists are ONLY offering medication mangement. I am also a psych undergrad student and I am also considering medical school. I would NOT be interested in medical school if that meant that (as a psychiatrist) I visited with my patients for only 15 minutes for their medication and provided NO therapy. Therapy is important to me, but so is medication. I want to be able to do both.

Example: In an employed setting, a psychiatrist may earn $150/hr and a counselor $50/hr. Why have the psychiatrist do an hour of counseling when you can have a counselor for 3 hours at the same price?

There are more nuances to this example, but you get the idea of why psychiatrists aren’t hired to do counseling. In your own private practice, you can do all of the counseling you want.

 

[psychacad]

Do you think that as a physician that your opportunities to provide therapy are as abundant as you would like? I am starting to notice that many psychiatrists are ONLY offering medication mangement. I am also a psych undergrad student and I am also considering medical school. I would NOT be interested in medical school if that meant that (as a psychiatrist) I visited with my patients for only 15 minutes for their medication and provided NO therapy. Therapy is important to me, but so is medication. I want to be able to do both.

You're coming to the field with the right attitude. I would say the major difference between good programs and the rest (and in some extension, good psychiatrists and the rest) is in therapy training. So make sure you pick a program with strong therapy exposure (at least 2/3 modalities). These tend to be the top 20-25%. I do think this should be a cornerstone of every residency program but unfortunately that's not how it works in reality given the structural pressures of 20 min "med visits". With regards to practice, this is employer-dependent, and fairly common in PP so you definitely have options to practice therapy. Keep in mind however that the benefits of therapy training aren't restricted to weekly/biweekly 45 min therapy sessions. Therapy will help you conceptualize cases so you can keep patients in treatment, help them comply with medications and overall connect with patients in a more therapeutic way.

 

[tr]

Also, consider that “good” doctoring is very therapeutic but doesn’t have to be “therapy.” A solid, empathic, 30-min encounter every month is sometimes more fulfilling that weekly hours of interpreting.

Erm, that might be because 'weekly hours of interpreting' (i.e., psychoanalysis?) doesn't have much of a track record of efficacy.

The effectiveness of long-term psychoanalytic psychotherapy—A meta-analysis of randomized controlled trials

The effectiveness of psychoanalysis and long-term psychoanalytic psychotherapy (LTPP) is debated. We evaluated the effectiveness of LTPP, compared to …

www.sciencedirect.com

I think we are fooling ourselves if we imagine that 30 minutes per month of supportive conversation sprinkled amongst the med management is equivalent to a focused course of an evidence-based psychotherapeutic modality targeted to the specific disorder.

 

[psychacad]

Erm, that might be because 'weekly hours of interpreting' (i.e., psychoanalysis?) doesn't have much of a track record of efficacy.

The effectiveness of long-term psychoanalytic psychotherapy—A meta-analysis of randomized controlled trials

The effectiveness of psychoanalysis and long-term psychoanalytic psychotherapy (LTPP) is debated. We evaluated the effectiveness of LTPP, compared to …

www.sciencedirect.com

I think we are fooling ourselves if we imagine that 30 minutes per month of supportive conversation sprinkled amongst the med management is equivalent to a focused course of an evidence-based psychotherapeutic modality targeted to the specific disorder.

That article is 9 years old. I think there's robust literature that psychodynamic therapy (short, intensive, even long term) is at least as effective as CBT in many disorders.

Psychiatry Online

ajp.psychiatryonline.org

 

[FrontierPsychiatry]

Well the problem you'll run into if you want to do psychiatry is that if you don't match you'll probably be miserable. If I didn't match psych there is a good chance I would have given up on medicine entirely

Having just started the medicine part of intern year, I have been thinking about this a lot lately. If I didn't match psychiatry I don't know if there is another field I could be happy in. And it's not even just the hours/culture which should get better after residency. It's the subject matter. I don't think I will ever get tired of treating psychosis, mania, depression, etc. However just the thought of having to spend my days treating CHF exacerbations makes me want to vomit. And then these is the theory and pathophysiology components which again are much more interesting in psychiatry for me(and im guessing everyone else in this thread). This probably wasn't as big of a concern when all you needed was a pulse to match psych, but now that field has become more competitive and a lot of good candidates fail to match it is definitely something that needs to be considered for people making the choice between psychiatry and psychology. Can you be happy doing general IM/FM if it comes down to it?

 

[tr]

That article is 9 years old. I think there's robust literature that psychodynamic therapy (short, intensive, even long term) is at least as effective as CBT in many disorders.

Psychiatry Online

ajp.psychiatryonline.org

Psychoanalysis != psychodynamic. I don't deny that psychodynamic may have its place in some situations. I doubt that 'weekly hours of interpreting' are efficacious in any scenario however. (I suspect the efficacious component of psychodynamically oriented interventions may have more to do with the emphasis on interpersonal aspects of the therapy and the transference/counter-transference relationship, but I confess this is speculative on my part.)

However, regarding the article you linked, does the below really look like equivalence to you?
To me it looks like superiority of CBT, generally, just with some pretty wide CIs (likely related to the outsize importance of non-modality-related factors in psychotherapeutic efficacy). As a thought experiment, if you happened to choose an 80% CI instead of 95%, in the graph below it looks like you'd have about five more studies besides Leichserving et al. in which CBT > PDT, but still none in which PDT > CBT.

 

[psychacad]

Psychoanalysis != psychodynamic. I don't deny that psychodynamic may have its place in some situations. I doubt that 'weekly hours of interpreting' are efficacious in any scenario however. (I suspect the efficacious component of psychodynamically oriented interventions may have more to do with the emphasis on interpersonal aspects of the therapy and the transference/counter-transference relationship, but I confess this is speculative on my part.)

[/QUOTE]

Totally agree with the latter part, but transference/counter-transference and interpersonal dynamics are pretty much the bread and butter of modern analytic techniques. In other words, interpretation doesn't happen only when the therapist explicitly interprets something. Interpersonal psychoanalysis has very long history and is contemporaneous to Freud. I don't get the swipe at psychoanalysis though. What is psychodynamic therapy besides taking analytic principles and employing them in a more practical setting? The difficulty with finding evidence for analysis has more to do with how hard it is to establish such a study. (how would you even control for that. Who sees patients for several days a week for years?).

However, regarding the article you linked, does the below really look like equivalence to you?

Yes. The whole point of the article is controlling for clinically meaningful difference. The chart you show shows a slight advantage for CBT but doesn't pass the test. Note that this is along one domain (post-treatment scores). There is essentially no difference when it comes to scores on follow up. Interestingly, the only domain that comes to close to significance is in psychosocial functioning in favor of dynamic (but fails a post-hoc test). This is actually quite intuitive since one of the claims of dynamic therapy is that it leads to more lasting/meaningful change.

It is a bit frustrating when people place "evidence-based therapies" on some kind of pedastal. What they really mean by "evidence" is tracking symptom scores durign the course of treatment. But if we are talking about actual evidence for clinical efficacy, there is plenty of it for PDT.

 

[Attending1985]

Consider practicing what you’re best at. I’d say “at top of your license” but I hate that phrase. Basically, your greatest value in the mental health treated hierarchy.

Your residency training experience will likely give you way more experience with medical evaluation and management (prescribing), compared to psychotherapy. Also, the types of therapies you’ll learn as part of the basic competency standards will be only applicable to good prognosis/easy/mild cases (ie, basic CBT and IPT). IMO, these people tend to get well with a PCP or counselor before seeing a psychiatrist. Many people looking for treatment in the community are complex/“difficult”/borderline—personality impaired. Those types of cases and therapeutic techniques, unless you arrange them yourself, are not experiences which are part of most residency curricula. Yes, you’ll get a PowerPoint on DBT but you won’t have near as many cases with good related supervision.

So, without advanced psychotherapy training, you are more suited and comfortable to treat things, even complex cases, with somatic therapy.

Also, consider that “good” doctoring is very therapeutic but doesn’t have to be “therapy.” A solid, empathic, 30-min encounter every month is sometimes more fulfilling that weekly hours of interpreting.

I would argue that practicing therapy in addition to or for some in lieu of medication is the top of our license. It what’s best for patients and will produce the best outcomes.