Half way through my B.S. and at a loss

[Jonq1102]

I will be very frank, the human mind fascinates me, much of the human body does as well (emt and ma) also I see biology and chemistry as annoying obstacles rather than interesting. I love listening to people's problems. I thought I should be a psychiatrist but my bio bases of behavior prof says she thinks I'm wasting my time and belong in a PsyD program. But I feel like no matter what I pick I lose. If I go to med school (according to my research) I will have the medical foundation but very little by ways of psychotherapy, she said I will just be a pill dispenser. But if I go the PsyD route it will be so focused that I will lose out on that medical foundation that I am interested by.

So what should I do? It seems if I choose medicine I lose out on psychotherapy, and if I choose psychotherapy I lose out on the medical model. I have to decide soon as all that is left for me are core classes. Thank you in advance!

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[snarfer]

I will be very frank, the human mind fascinates me, much of the human body does as well (emt and ma) also I see biology and chemistry as annoying obstacles rather than interesting. I love listening to people's problems. I thought I should be a psychiatrist but my bio bases of behavior prof says she thinks I'm wasting my time and belong in a PsyD program. But I feel like no matter what I pick I lose. If I go to med school (according to my research) I will have the medical foundation but very little by ways of psychotherapy, she said I will just be a pill dispenser. But if I go the PsyD route it will be so focused that I will lose out on that medical foundation that I am interested by.

So what should I do? It seems if I choose medicine I lose out on psychotherapy, and if I choose psychotherapy I lose out on the medical model. I have to decide soon as all that is left for me are core classes. Thank you in advance!

Personally I know quite a few psychiatrists in private practice and at academic centers seeing patients for both psychotherapy and biological managment. We also have TMS and ECT as treatment modalities if you are interested. You can order neuroimaging, labs,eeg, ekg to rule out interesting illnesses masquerading as psychiatric illness. PsyD or PhD can't do any of these things. After an assessment, you have more options to treat as a physician.

In residency, I had 1 year of 1:1 supervised cbt training. I also had 6 months of DBT training. then in fellowship I had closely supervised family therapy for a year. MET and supportive therapy were sprinkled in there as well but I didn't received the 1:1 supervision. There are quite a few programs with good to excellent all around training at both coasts.

Problem going with the PsyD, LCSW, PhD route is you're stuck with psychotherapy only, which really only works for patients with mild symptoms. In the real world, many patients do not want talk therapy. Plus, there is so much empathic listening one can take over the course of a lifetime.

 

[splik]

Complete the requirements for both - don't shut any doors at this stage.

I am not sure I believe that the difference in psychotherapy between clinical psychologists and psychiatrists is that big. Neither train to be psychotherapists, primarily, it is part of what they do. Clinical psychologists usually train in a scientist-practitioner model where they have a good grounding in the key perspectives and approaches in psychology, research methods and statistics, assessment, personality and intelligence testing, possibly some neuropsychological testing, diagnosis, case formulation, and of course psychotherapy - usually cognitive-behavioral therapy and also some other approaches.

Psychiatrists instead go to medical school where we learn to critically disengage and uncritically digest inhumane volumes of information, much of which is entirely useless. We then go on to gain clinical experience in internal medicine, surgery, obstetrics and gynecology, pediatrics, neurology (hopefully) and of course psychiatry. You become a little less empathic, a little more detached, possibly more cynical. Then we do an internship with at least 6 months of medicine and neurology, possibly more. Then you rotate through various bits of psychiatry (inpatient, general hospital, outpatient, addiction, child, forensics, emergency) where we learn diagnosis, formulation, psychopharmacology, management of complex ethical and legal problems, and yes psychotherapy. The most commonly taught psychotherapeutic modality in psychiatry residencies is psychodynamic therapy with many more programs teaching predominantly a psychodynamic approach than in clinical psychology programs. We learnt CBT too, but there is definitely a greater emphasis on dynamic psychiatry and psychotherapy, perhaps because treatment is usually longer term, and there is a lot more to learn, and indeed unlearn (such as the 'medical model' you mention, whatever that is). Unlike clinical psychologists, we don't subscribe to a particular theoretical model, which weakens the field on the one hand, but also makes it much harder to be criticized, since we are 'pluralistic', 'biopsychosocial', use 'multi-level model', are 'integrative', have 'interactional' approaches, and other meaningless phrases.

Whilst it is true most psychiatrists in private practice do not practice psychotherapy, this is partly by choice. There are geographic variations (i.e. NYC, Boston, California etc. all have more psychiatrists practicing psychotherapy, and more patients willing to go for psychotherapy). Then there is competition from other professionals. If the distinguishing feature of a psychiatrist is that he can prescribe, you can be sure, whether he admits it or not, he is going to prescribe because he can, because it's identity, because that's what he does, whether it's indicated or not. American psychiatrists seem more likely to use a combination of meds and therapy than their European counterparts where there is no incentive to prescribe medication of psychotherapy alone will do.

Yes if you become a psychiatrist, you might be a pill dispenser, but it will be through choice, even if it is one you don't remember making. It will also mean you won't be a very good psychiatrist.

see: http://archpsyc.ama-assn.org/cgi/content/full/65/8/962
and http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=2&pagewanted=all

 

[Jonq1102]

Complete the requirements for both - don't shut any doors at this stage.

I am not sure I believe that the difference in psychotherapy between clinical psychologists and psychiatrists is that big. Neither train to be psychotherapists, primarily, it is part of what they do. Clinical psychologists usually train in a scientist-practitioner model where they have a good grounding in the key perspectives and approaches in psychology, research methods and statistics, assessment, personality and intelligence testing, possibly some neuropsychological testing, diagnosis, case formulation, and of course psychotherapy - usually cognitive-behavioral therapy and also some other approaches.

Psychiatrists instead go to medical school where we learn to critically disengage and uncritically digest inhumane volumes of information, much of which is entirely useless. We then go on to gain clinical experience in internal medicine, surgery, obstetrics and gynecology, pediatrics, neurology (hopefully) and of course psychiatry. You become a little less empathic, a little more detached, possibly more cynical. Then we do an internship with at least 6 months of medicine and neurology, possibly more. Then you rotate through various bits of psychiatry (inpatient, general hospital, outpatient, addiction, child, forensics, emergency) where we learn diagnosis, formulation, psychopharmacology, management of complex ethical and legal problems, and yes psychotherapy. The most commonly taught psychotherapeutic modality in psychiatry residencies is psychodynamic therapy with many more programs teaching predominantly a psychodynamic approach than in clinical psychology programs. We learnt CBT too, but there is definitely a greater emphasis on dynamic psychiatry and psychotherapy, perhaps because treatment is usually longer term, and there is a lot more to learn, and indeed unlearn (such as the 'medical model' you mention, whatever that is). Unlike clinical psychologists, we don't subscribe to a particular theoretical model, which weakens the field on the one hand, but also makes it much harder to be criticized, since we are 'pluralistic', 'biopsychosocial', use 'multi-level model', are 'integrative', have 'interactional' approaches, and other meaningless phrases.

Whilst it is true most psychiatrists in private practice do not practice psychotherapy, this is partly by choice. There are geographic variations (i.e. NYC, Boston, California etc. all have more psychiatrists practicing psychotherapy, and more patients willing to go for psychotherapy). Then there is competition from other professionals. If the distinguishing feature of a psychiatrist is that he can prescribe, you can be sure, whether he admits it or not, he is going to prescribe because he can, because it's identity, because that's what he does, whether it's indicated or not. American psychiatrists seem more likely to use a combination of meds and therapy than their European counterparts where there is no incentive to prescribe medication of psychotherapy alone will do.

Yes if you become a psychiatrist, you might be a pill dispenser, but it will be through choice, even if it is one you don't remember making. It will also mean you won't be a very good psychiatrist.

see: http://archpsyc.ama-assn.org/cgi/content/full/65/8/962
and http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=2&pagewanted=all

Thank you I read the articles and that's exactly what I want to avoid, being that guy who wishes he could've kept doing what he loved instead of doing what he has to.

 

[billypilgrim37]

I have found that there are no worse providers of information about mental health careers than those who teach psychology undergraduates. Their concepts of both clinical psychology and psychiatry are absurd and infantilizing. Find some practicing psychologists and psychiatrists and talk to them, and try to forget everything your "biological basis of behavior" prof says. When I took that class, I kept a page in the back of my notebook for all the scientific inaccuracies mentioned in the class. Things like animal cells having cell walls, twins being the result of two sperm fertilizing an egg, etc. All from a guy whose (poorly-funded, thank god) research was giving pigeons drugs of abuse and watching them fly around. He said very stupid things about psychiatry, and I even learned later that many of the things he said about clinical psychology were simple-minded and untrue.

When people say that psychiatrists do nothing but push pills, they fundamentally don't understand what (good) psychiatrists do. The end result of most of our clinic visits involve a prescription, yes, but the way we get there (or don't get there), the assessment and interaction in between, the collaboration and coordination, are things that generally elude our critics.

Recognize as well that many psychologists and psychiatrists see a very different population. Psychologists see many folks with milder pathology as well as a smaller number of folks with more severe pathology (a result of the fact that there are just many more people with milder pathology, statistically). Psychiatrists generally only wind up seeing folks who are referred to them after either a PCP or a therapist believes the person needs more expertise and assistance. Most of the folks we see are the ones who are sick enough and have been screened enough by the system that more aggressive intervention makes sense. If you threw pills at everybody that walked into a psychologist's office, that would probably be absurd. But prescribing to most of the folks that walk into a psychiatrist's office makes a lot of sense.

Both psyd/phd and md/do routes can produce wonderful practioners of mental health that provide life-saving, valuable care to patients. They do different but very complementary things. They are both worthy of your consideration. But don't consider either based on what your undergraduate psychology/neuroscience professors say. They will just tell you that animal cells have cell walls.

 

[Jonq1102]

I have found that there are no worse providers of information about mental health careers than those who teach psychology undergraduates. Their concepts of both clinical psychology and psychiatry are absurd and infantilizing. Find some practicing psychologists and psychiatrists and talk to them, and try to forget everything your "biological basis of behavior" prof says. When I took that class, I kept a page in the back of my notebook for all the scientific inaccuracies mentioned in the class. Things like animal cells having cell walls, twins being the result of two sperm fertilizing an egg, etc. All from a guy whose (poorly-funded, thank god) research was giving pigeons drugs of abuse and watching them fly around. He said very stupid things about psychiatry, and I even learned later that many of the things he said about clinical psychology were simple-minded and untrue.

When people say that psychiatrists do nothing but push pills, they fundamentally don't understand what (good) psychiatrists do. The end result of most of our clinic visits involve a prescription, yes, but the way we get there (or don't get there), the assessment and interaction in between, the collaboration and coordination, are things that generally elude our critics.

Recognize as well that many psychologists and psychiatrists see a very different population. Psychologists see many folks with milder pathology as well as a smaller number of folks with more severe pathology (a result of the fact that there are just many more people with milder pathology, statistically). Psychiatrists generally only wind up seeing folks who are referred to them after either a PCP or a therapist believes the person needs more expertise and assistance. Most of the folks we see are the ones who are sick enough and have been screened enough by the system that more aggressive intervention makes sense. If you threw pills at everybody that walked into a psychologist's office, that would probably be absurd. But prescribing to most of the folks that walk into a psychiatrist's office makes a lot of sense.

Both psyd/phd and md/do routes can produce wonderful practioners of mental health that provide life-saving, valuable care to patients. They do different but very complementary things. They are both worthy of your consideration. But don't consider either based on what your undergraduate psychology/neuroscience professors say. They will just tell you that animal cells have cell walls.

So in the way that you practice is there room for any psychotherapy or because of the population you see is it unnecessary?

 

[digitlnoize]

I will be very frank, the human mind fascinates me, much of the human body does as well (emt and ma) also I see biology and chemistry as annoying obstacles rather than interesting. I love listening to people's problems. I thought I should be a psychiatrist but my bio bases of behavior prof says she thinks I'm wasting my time and belong in a PsyD program. But I feel like no matter what I pick I lose. If I go to med school (according to my research) I will have the medical foundation but very little by ways of psychotherapy, she said I will just be a pill dispenser. But if I go the PsyD route it will be so focused that I will lose out on that medical foundation that I am interested by.

So what should I do? It seems if I choose medicine I lose out on psychotherapy, and if I choose psychotherapy I lose out on the medical model. I have to decide soon as all that is left for me are core classes. Thank you in advance!

Plenty of psychiatrists do therapy, and as long as you pick a residency program that emphasizes therapy, you'll have plenty of opportunity to learn it and get good at it.

That being said, I wouldn't go the medicine route unless you're interested in learning about all facets of medicine though. Fortunately, mental illness is pervasive across all specialties of medicine, so even on your surgery or OBGYN rotations you'll have MORE than enough time to get in some psych practice.

Also, I am amazed by how much I'd miss as a mental health provider if I had NOT gone to med school.

I saw an anxious/depressed patient once. A good history and exam revealed a history of strange heart arrhythmias, muscle/joint aches, psych complaints, and a nice healthy tan for a guy living in the Virginia winter. Basic labs showed some liver enzyme elevation. Hmm. Iron studies? Yep. Hemochromatosis.

This is just one example, but the best one I have of how so many psych patients are written off as "psych patients" before someone does a true workup of the problem. If I was a non-doctor provider, I probably would miss all of these things because I would lack the medical training to recognize them, unless they were so obvious that your grandma could diagnose it.

Is the psychotic patient schizophrenic, or do they have a brain tumor? How can you tell? Is the depressed patient "depressed" or hypothyroid? These lists can be much bigger, but you get the idea.

I'm not saying that psychologists suck or anything...they are great at what they do. But what they do isn't what I do.

 

[Jonq1102]

Plenty of psychiatrists do therapy, and as long as you pick a residency program that emphasizes therapy, you'll have plenty of opportunity to learn it and get good at it.

That being said, I wouldn't go the medicine route unless you're interested in learning about all facets of medicine though. Fortunately, mental illness is pervasive across all specialties of medicine, so even on your surgery or OBGYN rotations you'll have MORE than enough time to get in some psych practice.

Also, I am amazed by how much I'd miss as a mental health provider if I had NOT gone to med school.

I saw an anxious/depressed patient once. A good history and exam revealed a history of strange heart arrhythmias, muscle/joint aches, psych complaints, and a nice healthy tan for a guy living in the Virginia winter. Basic labs showed some liver enzyme elevation. Hmm. Iron studies? Yep. Hemochromatosis.

This is just one example, but the best one I have of how so many psych patients are written off as "psych patients" before someone does a true workup of the problem. If I was a non-doctor provider, I probably would miss all of these things because I would lack the medical training to recognize them, unless they were so obvious that your grandma could diagnose it.

Is the psychotic patient schizophrenic, or do they have a brain tumor? How can you tell? Is the depressed patient "depressed" or hypothyroid? These lists can be much bigger, but you get the idea.

I'm not saying that psychologists suck or anything...they are great at what they do. But what they do isn't what I do.

Thank you all for your advice! It seems I should stay on the path to med school after all.

 

[digitlnoize]

Thank you all for your advice! It seems I should stay on the path to med school after all.

Possibly. Again, this is just MY take on it, but if you agree, then maybe med school is the right choice.

I will tell you that med school has been a lot of hard work, but it's also been one of the best times of my life. I've met some amazing friends, seen a lot of really neat stuff, met a lot of interesting people, and travelled to some really cool places.

I've also spent a crapload of money...but that's another story. Fortunately, the salary cap on doctors is typically much, much higher than other fields, so it's not impossible to make it back. I would caution you that therapy TENDS to be reimbursed at a lower rate, so if you really, really want to do therapy, try and figure out ways you can save as much money as possible during undergrad and med school. Lower loans = less financial pressure on you to do med management to make more money.

Be aware of the money thing, but don't be afraid of it. There are plenty of ways to make it go away in the end. Military, PSLF program, hiring incentives, scholarships, etc, etc. Plenty of ways. It sucks, but it could be worse.

 

[Jonq1102]

Possibly. Again, this is just MY take on it, but if you agree, then maybe med school is the right choice.

I will tell you that med school has been a lot of hard work, but it's also been one of the best times of my life. I've met some amazing friends, seen a lot of really neat stuff, met a lot of interesting people, and travelled to some really cool places.

I've also spent a crapload of money...but that's another story. Fortunately, the salary cap on doctors is typically much, much higher than other fields, so it's not impossible to make it back. I would caution you that therapy TENDS to be reimbursed at a lower rate, so if you really, really want to do therapy, try and figure out ways you can save as much money as possible during undergrad and med school. Lower loans = less financial pressure on you to do med management to make more money.

Be aware of the money thing, but don't be afraid of it. There are plenty of ways to make it go away in the end. Military, PSLF program, hiring incentives, scholarships, etc, etc. Plenty of ways. It sucks, but it could be worse.

I do agree, it makes a lot of sense. I'm not concerned with the money as I plan to go back to the military with my new skillset. I do have one more question though, I'm currently a Bio major/Behavioral Neurosci minor. but because of all the core I'm missing I have a ways to go and my current school is very expensive, would you condone switching my major to Psych major/Behave Neuro minor and then going to a state university (fraction of the cost) for the med school prereqs? Doing that would cut my time here by more than half as I have almost all the requirements for the psych B.S. and because of my past indecisiveness I am almost at my undergrad fafsa limit.

 

[snarfer]

Find some practicing psychologists and psychiatrists and talk to them

I would suggest that when you talk to a psychologist, ask them about their training and what they do only and disregard what they think psychiatrists or internists or anyone who had medical training do. Many of these folks are misinformed about our training. Envy, bias and defensiveness may be a factor. I'm always suprise that they don't look up online to learn about our training. Most MDs seem to know PHD/PsyD/LCSW training protocol and what they do but not vice versa.

 

[AcronymAllergy]

I would suggest that when you talk to a psychologist, ask them about their training and what they do only and disregard what they think psychiatrists or internists or anyone who had medical training do. Many of these folks are misinformed about our training. Envy, bias and defensiveness may be a factor. I'm always suprise that they don't look up online to learn about our training. Most MDs seem to know PHD/PsyD/LCSW training protocol and what they do but not vice versa.

I'd say it's a good idea to go to a primary source regardless of what it is you're inquiring about. I wouldn't ask a psychologist what a psychiatrist does any sooner than I'd ask a psychiatrist what a psychologist does, nor would I ask either professional what a social worker does.

I'd definitely also suggest, if possible, speaking to multiple individuals, as viewpoints and daily responsibilities can vary quite significantly even within the same clinic or department. As splik mentioned, completing the pre-reqs for both paths is probably your best bet at the moment.

 

[billypilgrim37]

i have a ways to go and my current school is very expensive, would you condone switching my major to psych major/behave neuro minor and then going to a state university (fraction of the cost) for the med school prereqs? Doing that would cut my time here by more than half as i have almost all the requirements for the psych b.s. And because of my past indecisiveness i am almost at my undergrad fafsa limit.

absolutely!

 

[ShrunkenHeads]

I don't know if it was mentioned here, but you could consider what I'm thinking of doing - neuropsych. I'm having a similar dilemma (not wanting to be a pill pusher, whether by choice or whatever). There's a chance I might skip psychiatry altogether and go into neuroscience (phd - though it's very hard to see myself solely doing research, I need interaction with people) or neurology, but I've got some time to decide. I can only encourage you to get as much info from here as you can and from as many other sources as possible in order to come up with a well informed decision.

Also keep in mind that there are areas of specialty that might interest you (eg. Addiction, Forensics etc)

Oh yeah and as mentioned earlier in the thread, shadowing some psychologists/psychiatrists is an awesome idea.

 

[ShrunkenHeads]

Plenty of psychiatrists do therapy, and as long as you pick a residency program that emphasizes therapy, you'll have plenty of opportunity to learn it and get good at it.

That being said, I wouldn't go the medicine route unless you're interested in learning about all facets of medicine though. Fortunately, mental illness is pervasive across all specialties of medicine, so even on your surgery or OBGYN rotations you'll have MORE than enough time to get in some psych practice.

Also, I am amazed by how much I'd miss as a mental health provider if I had NOT gone to med school.

I saw an anxious/depressed patient once. A good history and exam revealed a history of strange heart arrhythmias, muscle/joint aches, psych complaints, and a nice healthy tan for a guy living in the Virginia winter. Basic labs showed some liver enzyme elevation. Hmm. Iron studies? Yep. Hemochromatosis.

This is just one example, but the best one I have of how so many psych patients are written off as "psych patients" before someone does a true workup of the problem. If I was a non-doctor provider, I probably would miss all of these things because I would lack the medical training to recognize them, unless they were so obvious that your grandma could diagnose it.

Is the psychotic patient schizophrenic, or do they have a brain tumor? How can you tell? Is the depressed patient "depressed" or hypothyroid? These lists can be much bigger, but you get the idea.

I'm not saying that psychologists suck or anything...they are great at what they do. But what they do isn't what I do.

True, good points.