Fretting over whether to become a Psychiatrist or -ologist

[Fai]

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Hey guys, let me clarify my stance here:

I absolutely know the difference between a psychiatrist and psychologist. Not only are they in two completely routes (-iatrists get their M.D or D.Os and -ologists get their Ph.Ds/Psy.Ds) the psychiatrist is first and foremost a physician before a psychotherapist.

Now with that understanding, I'm troubled about which one suits what I want to do. I believe strongly in intergration of psychiatric drugs and psychotherapy by one person for a patient. I feel like the patient would do better with his/her prescriber being the one to provide therapy rather than the doctor getting a follow-up from a seperate party (psychologist or social worker) about how they are doing. I see that it'd be best to just go to one provider instead of going to a doc for medicine, and a therapist for the ongoing problem (say, anxiety).

I love both therapy and medicine. Although I'm leaning to go pre-med because I might find another speciality that would interest me (I'm interested in biology/anatomy and medicine moreso than psychology but I plan to major in Psych), I always wanted to help people with their psychological problems and let them know that they have someone that they could talk to and help them feel better about themselves and such.

I'm disappointed to hear that more and more psychiatrists are not doing psychotherapy anymore, and although I haven't shadowed one before I figure 15 minute med checks would be boring. I'd like to do a med check followed by a therapy session to get to know what is causing the illness, and the like. An example I'll use is anxiety. Maybe this person doesn't need a SSRI afterall because it's just stress from a short-term situation and they just need to let it out or maybe they could benefit from a benzo instead etc.

My view is more likely than not far-fetched but, is Psychiatry the one I should pursue (should I take that speciality through med school) or because I really want to do psychotherapy, pursue Psychology and get a Ph.D instead?

Hefty amount of writing I know but, thanks in advance!

 

[Morsetlis]

After going through med school, you most likely will not bother with (or even remember) psychotherapy anymore. There IS a reason why most psychiatrists prefer drugs. Perhaps you could find a Psychiatry residency where they emphasize discrete modalities, such as: http://www.usahealthsystem.com/psychiatry ?

But before you set off on the path, remember that before Psychiatry residency is 4 years of med school that has very little to do with the mind and very much to do with the body.

However, SDN does have a Psychiatry forum. Go there and seek the opinions of those people too...

 

[Tin Man]

After going through med school, you most likely will not bother with (or even remember) psychotherapy anymore. There IS a reason why most psychiatrists prefer drugs.

Wut.

I don't feel intimidated disagreeing with you here, given that you have three months in medical school, and are already trying to say what the OP can expect to remember after medical school is over. 🙄 Not sure what your degree was in, but mine was in psychology, and I have yet to encounter a single psychiatrist that was not at least trained in most modern forms of psychotherapy during their medical training.

There's absolutely nothing stopping a psychiatrist from choosing to practice however he/she wants, whether with medication or with therapies. Psychiatrists are known as "medication dispensers" because:

A) Many of them are corporate shills for pharmaceutical companies. 😀
B) We have so many wonderdrugs out there that an overworked psychiatrist may find it easier/faster to continuously give out pills than to use therapies.

Check it: http://www.kevinmd.com/blog/2011/06/decision-point-psychiatrists-faced-psychotherapy.html

The point is that while you'll probably end up spending more time with fewer patients (and therefore make less money), you can and certainly will find most credible psychiatry residences (at least from the quick look I've had) will offer training in psychotherapy.

I'm not anti-pill, but I also recognize, as does mainstream medicine, that there isn't much out there in the way of psychiatric "cures" in pill form. Almost every pill, whether an SSRI, Ritalin, or whatever, is designed to be used continuously to fight of the symptoms. If a disorder can actually be treated, that's going to be by-and-large the realm of psychotherapy, lifestyle changes, and other non-pharmacological methods of treatment. Even the evil medical industrial complex recognizes that.

 

[kduck]

This is just an idea, but you might consider MD/PhD? That way you could get a PhD in psychology. I don't know too much about all the different kinds of MD/PhD programs, but I believe there are some that let you do your PhD in whatever you like.

 

[Starlightembers]

Fai;

You are correct in saying that, these day, many -- if not most -- psychiatrists no longer use psychotherapy with their patients. That does not mean, however, that they can't; they absolutely can. The fact that less and less psychiatrists are doing psychotherapy is an expression of nothing more than the fact that there is financial incentive not to. See, insurance companies won't pay you much more (if anything more at all) for seeing a patient for an hour of therapy than they would for seeing that same patient for a 15 minute medication check. In other words, the person who does four 15 minute appointments in one hour is going to make four times as much as the doctor who does one, hour-long session. Knowing that, is it any surprise that many have walked away from psychotherapy?

Fortunately, if you are willing to get paid less than your medication-only colleagues and are OK going into private or group practice (there isn't really any one-on-one therapy being done in hospitals by anybody, as most hospital stays are only 6 - 10 days long), you can still practice psychotherapy with your patients. In fact, many still do; a quick look in SDN's own Psychiatry board will show you numerous members, both residents and attendings, defending the practice.

(For what it's worth, I've been seeing my psychiatrist for about three years now and not once during that time have I only had fifteen minutes with him; he still believes in and does full psychotherapy with his patients and, as someone who at one point had to be on medication, I can say that I'm much better off having been able to get it all through one provider. Hopefully, when/if I get there, I will be able to do the same for my patients.)

Furthermore, you will be trained to do it in residency, though how much will depend on the program you match into and how you choose to spend your elective time (but all have it. See/look through all PGYs: http://columbiapsychiatry.org/residency/curriculum, http://www.cornellpsychiatry.org/education/pgy2_clinical.html, http://psychiatry.yale.edu/education/residency/training/psychotherapy.aspx, etc); some programs even allow their residents to take on "psychotherapy tracks", where they gain even more training in it (http://www.upstate.edu/psych/education/psychotherapy/psych_track.php, http://www.einstein.yu.edu/psychiatry/residency/specialprogramshome.htm, etc). If you still feel that's not enough, you can even do a fellowship after residency just focusing on learning more psychotherapy techniques (http://www.psychoanalysis.columbia.edu/explore/psychoanalytic-fellowship).

This is just an idea, but you might consider MD/PhD? That way you could get a PhD in psychology. I don't know too much about all the different kinds of MD/PhD programs, but I believe there are some that let you do your PhD in whatever you like.

You are correct in saying that there are MD/PhD programs that allow you to pursue your PhD in Psychology; however, as far as I know, there are no programs that allow you to pursue the PhD in Clinical Psychology (most Psychology PhDs are non-clinical and are designed to train researchers). There would be no point -- if a medical student wants to treat those with mental illness, they should/would just become a psychiatrist.

Star

 

[Valadi]

You can be a psychiatrist and do therapy. Hell, most now even do therapy out of pocket since insurance pays almost nothing for it (when it is covered). If you want to do pure consult-liason psych, you can be purely hospital based and not have to do any therapy at all.

There is evidence that psychotherapy is beneficial in many conditions. For the most part, these will be referred to appropriate people to perform it. You can be a psychiatrist and perform cognitive behavior therapy, dialectical bt, or any other therapy. You could also be a clinical psychologist and do the same.

If you want to perform psychoanalysis, then the psychiatry path is what you're looking for.

If it were me, I think 1 hour CBT sessions would get just as boring as med checks after awhile. C/L psych is cool as hell. If I couldn't go into surgery, I would take that route in a heartbeat.

 

[k488k488]

The big difference in the end is that Psychiatrists can prescribe meds, and Psychologists cannot. Psychiatrists CAN do psychotherapy if they are trained and if they choose.

 

[Therapist4Chnge]

You are correct in saying that there are MD/PhD programs that allow you to pursue your PhD in Psychology; however, as far as I know, there are no programs that allow you to pursue the PhD in Clinical Psychology (most Psychology PhDs are non-clinical and are designed to train researchers). There would be no point -- if a medical student wants to treat those with mental illness, they should/would just become a psychiatrist.

I believe you are mistaken. The Ph.D. of an M.D./Ph.D. is (almost without exception) in a hard science and/or directly applicable to medicine. A medical school is not going to fund your Ph.D. in anything that doesn't land you in academic medicine. I looked all over the country at M.D./Ph.D. programs, and none of them had anything remotely related to Clinical Psychology because the training would be closer to 2 decades! Many of the classes in med school get counted towards the Ph.D., which could not happen with a Clinical Psychology Ph.D.