I've gotta ask; is psychiatry right for me?

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Ashleft

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I've been reading SDN for a little while now and really admire how helpful everyone is to each other. This question has been asked before, but I can only do so much reading.

I'm still in undergrad, and while my credits technically give me junior status this is only my second year. I'm a psychology major and, until now, I've been looking into counseling or clinical psychology. Here's why I'm strongly considering psychiatry:

  • I'll get to combine helping people with a thorough understanding of how the body works
  • I'd still get to practice psychotherapy if I complete a program for it
  • I'm interested in health, but I find the brain to be particularly interesting
  • Psychiatry seems more science-based, provides more job stability, and is in high demand
  • I'm far more interested in practice than research
  • I'm willing to dedicate several years to schooling
  • I'd enter the workforce sooner
  • The hours seem flexible and manageable, and the pay is much better than psychology
My main worries would be my squeamishness (which would mainly only come up in med school, and I could toughen up and get over it), personal health issues (which only continue to get better, so hopefully it wouldn't interfere too much), and lingering uneasiness about prescribing medicine (which should dissolve once I've had experience in the field).

I'm currently taking biopsychology and love it. I'm in the process of transferring schools, and while I can graduate next year I'm open to staying in undergrad an extra year to complete premed. As of now I have a high GPA and some community service hours under my belt, which is somewhat of a start, and I plan to contact some local psychiatrists about shadowing in the upcoming months to give me a better idea of the field. I've been reading a lot about the field, too.

What other steps should I take, and what other things should I consider? Are there any glaring issues with what I've presented that should cause me to reconsider? Do ya hate me for being the millionth person to ask this question? Thanks for reading all of this!

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... Here's why I'm strongly considering psychiatry:
...
  • I'm far more interested in practice than research
  • I'm willing to dedicate several years to schooling
  • I'd enter the workforce sooner
  • The hours seems flexible and manageable, and the pay is much better than psychology
Not so sure about this one...
 
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Not so sure about this one...
Good point. I'm considering residency entering the workforce since I'd be getting paid for it. So 6 years (2 more years undergrad plus 4 years med school) versus ~7 years (1 more year undergrad, 6+ years grad school). It's kinda relative to the path I take, so it's probably about the same.
 
Sounds like you've thought about it pretty well. Do some volunteering, shadowing psychiatrists, or do some other work in mental health. If you still have interest then go for it!
 
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Sounds like you've thought about it pretty well. Do some volunteering, shadowing psychiatrists, or do some other work in mental health. If you still have interest then go for it!
In my experience, shadowing psychiatrists is nearly impossible.
 
  • Psychiatry seems more science-based, provides more job stability, and is in high demand
umm a phd in clinical psychology is a helluva lot more science based than any psychiatry residency. If you mean more biologically based, then that would be true for psychiatry. but PhD clinical psychology programs are usually based on a scientist-practitioner model and they are taught to apply psychological theories to patient care, as well understand experimental design, psychometrics, and statistics in a way that is more rigorous than medical and psychiatric training. Their interventions are more likely to be hypothesis driven and theory based in an explicit way. Obviously there are many dubious psychology diploma mills where this isn't the case, but I would say that the scientific basis of psychiatry residency training is severely wanting and even wrote a little piece on how what was being taught was closer to pseudoscience.
 
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umm a phd in clinical psychology is a helluva lot more science based than any psychiatry residency. If you mean more biologically based, then that would be true for psychiatry. but PhD clinical psychology programs are usually based on a scientist-practitioner model and they are taught to apply psychological theories to patient care, as well understand experimental design, psychometrics, and statistics in a way that is more rigorous than medical and psychiatric training. Their interventions are more likely to be hypothesis driven and theory based in an explicit way. Obviously there are many dubious psychology diploma mills where this isn't the case, but I would say that the scientific basis of psychiatry residency training is severely wanting and even wrote a little piece on how what was being taught was closer to pseudoscience.

What you're saying makes sense. I do mean more biologically based, and I don't mean to discount the dedication it takes to be involved with clinical psychology (in fact, the I've found experimental design to be difficult, which is why I'm not as interested in pursuing it). If you have the link, I'd like to read the piece you wrote :)
 
but PhD clinical psychology programs are usually based on a scientist-practitioner model and they are taught to apply psychological theories to patient care, as well understand experimental design, psychometrics, and statistics in a way that is more rigorous than medical and psychiatric training. Their interventions are more likely to be hypothesis driven and theory based in an explicit way.
Agree with this, though I wouldn't limit this to psychiatry.

Psychology and PhD programs have a much more rigorous scientific and theory driven practice than medical residency.

Residency in general is based on the apprenticeship model and that's changed relatively little in the past several generations. This isn't unique to psych.
 
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...Psychology and PhD programs have a much more rigorous scientific and theory driven practice than medical residency...

More science in psychology programs than medicine residency??? Please list the science you're talking about. Medicine is all about studying the structure and function of the human body. Psychology studies the the behavior of people and the mind. I could argue the science of medicine is much more rigorous than that of psychology. Ever hear a doctor explain the pathophysiology of how nephritic syndromes affect each bodily system, including why the pathology of the basement membranes of the kidney look the way they do, and how those systems respond to various pharmacological interventions over time and correlate all that to the clinical picture of the patient? Please, I'm choking on my morning tea here.
 
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More science in psychology programs than medicine residency??? Please list the science you're talking about. Medicine is all about studying the structure and function of the human body. Psychology studies the the behavior of people and the mind. I could argue the science of medicine is much more rigorous than that of psychology. Ever hear a doctor explain the pathophysiology of how nephritic syndromes affect each bodily system, including why the pathology of the basement membranes of the kidney look the way they do, and how those systems respond to various pharmacological interventions over time and correlate all that to the clinical picture of the patient? Please, I'm choking on my morning tea here.

Psychologists are without a doubt vastly better-trained to do science than your average medical resident. Memorizing details from a textbook or at the knee of a more senior clinician does not make you a scientist, regardless of what methods were used to discover those details in the first place.
 
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Psychologists have more practice/training in utilizing the scientific method, and in a more rigorous manner. Physicians have studied more scientific disciplines (biology, chemistry, physics, physiology, biochemistry, etc.).
 
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Psychologists are without a doubt vastly better-trained to do science than your average medical resident. Memorizing details from a textbook or at the knee of a more senior clinician does not make you a scientist, regardless of what methods were used to discover those details in the first place.

I'm not talking about setting up a simple research study. Psychological studies are some of the most straight-forward studies I've ever seen. Try setting up a basic science study, or a research study on cancer medicine, or a biomedical engineering research study. Most, and I mean most, med students have been actively engaged in scientific research, and on a more complex level than a psychological study.

And I disagree that the average medical student is less knowledgable about "doing science" than a psychology student since all medical schools in the USA place a huge emphasis on science research. I was on the admissions committee of a prestigious medical school so I do happen to know this.

I'm insulted by your claim that we medical residents amount to people memorizing information.

Clearly you're not in medicine. The complexity and mental challenge of managing, say, a very sick patient in the ICU involves a high level of intelligence to synthesize tons of information that's changing by the day if not the hour, understanding the physics of pulmonology to manage ventilation machines, thinking about how 10 or 15 medications interact with each other (this alone requires processing prowess), and then incorporating the interventions of other specialists like cardiology, infectious disease, etc, to all work together to bring about better health for the patient. It's the most complex form of work imaginable and it goes 100 miles beyond "memorizing" information.

You're like the rest of the people "on the outside". Nobody will understand the science, complexity, and demand of treating complex patients unless they actually do it.
 
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Psychologists have more practice/training in utilizing the scientific method, and in a more rigorous manner. Physicians have studied more scientific disciplines (biology, chemistry, physics, physiology, biochemistry, etc.).

Training curricula of medical schools are much more progressive than 10 years ago, and part of that progression has required research training for every student along with focused study in statistics and research study design - tearing apart studies, picking them apart for biases, redesigning them, offering more statistically powerful solutions, things like this.

I just think people on the outside stereotype doctors and med students as book automatons. Just because we have to memorize TONS of information, doesn't mean we stop there. It provides the solid foundation in years 1 and 2 of med school so that by the time residency comes around we're applying that knowledge on advanced levels.
 
I've been reading SDN for a little while now and really admire how helpful everyone is to each other. This question has been asked before, but I can only do so much reading.

I'm still in undergrad, and while my credits technically give me junior status this is only my second year. I'm a psychology major and, until now, I've been looking into counseling or clinical psychology. Here's why I'm strongly considering psychiatry:

  • I'll get to combine helping people with a thorough understanding of how the body works
  • I'd still get to practice psychotherapy if I complete a program for it
  • I'm interested in health, but I find the brain to be particularly interesting
  • Psychiatry seems more science-based, provides more job stability, and is in high demand
  • I'm far more interested in practice than research
  • I'm willing to dedicate several years to schooling
  • I'd enter the workforce sooner
  • The hours seem flexible and manageable, and the pay is much better than psychology
My main worries would be my squeamishness (which would mainly only come up in med school, and I could toughen up and get over it), personal health issues (which only continue to get better, so hopefully it wouldn't interfere too much), and lingering uneasiness about prescribing medicine (which should dissolve once I've had experience in the field).

I'm currently taking biopsychology and love it. I'm in the process of transferring schools, and while I can graduate next year I'm open to staying in undergrad an extra year to complete premed. As of now I have a high GPA and some community service hours under my belt, which is somewhat of a start, and I plan to contact some local psychiatrists about shadowing in the upcoming months to give me a better idea of the field. I've been reading a lot about the field, too.

What other steps should I take, and what other things should I consider? Are there any glaring issues with what I've presented that should cause me to reconsider? Do ya hate me for being the millionth person to ask this question? Thanks for reading all of this!
What is the lingering uneasiness about prescribing? As a psychologist who primarily does psychotherapy, I am relieved that I don't have to deal with the issues that a psychiatrist has to deal with as the holder of the prescription pad and the "magic pill". On the other hand it is disappointing that I cannot directly help patients who can greatly benefit from appropriate medications. Especially when it takes more than a few months to get into see a psychiatrist and in the meantime the PCP wants to know from me what they should prescribe and what dosage to initiate.

If I had to do it all over again, I really don't know which route I would take, but the biggest reason of all that makes me doubt my decision is money. Even the lowest paid full-time psychiatrist makes substantially more than me and I am in the 90th %ile of psychologists. I love being a psychologist and will brag about what we bring to the table all day long, but if I was a psychiatrist, I would easily have double the income.
 
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Training curricula of medical schools are much more progressive than 10 years ago, and part of that progression has required research training for every student along with focused study in statistics and research study design - tearing apart studies, picking them apart for biases, redesigning them, offering more statistically powerful solutions, things like this.

I just think people on the outside stereotype doctors and med students as book automatons. Just because we have to memorize TONS of information, doesn't mean we stop there. It provides the solid foundation in years 1 and 2 of med school so that by the time residency comes around we're applying that knowledge on advanced levels.

Contra your assertions that I am "clearly not in medicine", I am in my 4th year of medical school. 1st and 2nd years were spent with lecture after lecture of bald assertions of facts as more or less arbitrarily true. There is very good reason for that - above all students must be prepared these days for board exams - but there wasn't even a scintilla of the critical thinking one gets in a first-year seminar of your average academic graduate program. Some of those facts happened to be related to each other in a structured way, but perhaps with the exception of renal physiology, it was a structure built on "these things appear to be true-ish statements about the world, you need to know them to do useful things." Medical school is much better understand as a kind of trade/professional school than graduate school in the traditional sense. One giveaway that reasoning and careful interpretation of empirical data is not really the main object of instruction: medical school exams are overwhelmingly multiple choice tests.

I will pay you cash money if you can find a PhD scientist who took a multiple choice test of any kind during graduate school as part of their coursework.

So far as your ICU example is concerned, of course it is difficult! It is a complex engineering problem that requires a high degree of proficiency in summarizing a large body of information in a useful fashion and manipulating simple mathematical models of a complex system in real time. It clearly requires a high degree of precision and processing. So does playing chess, as the literally thousands of volumes of chess theory attest, many of which focus exclusively on the first half dozen moves of the game. Neither of them is science, although in the ICU case you are of course using a large body of facts that were ultimately derived via scientific methods.

Med students acting as lab monkeys does very little to invalidate this point. Sure, some people with MDs do science. But it was not because their MD curriculum taught them anything about how to do that. I don't know what you think a "basic psychological study" is, but frequently the tricky part is not in the design itself, but determining what would constitute a legitimate test of a hypothesis under consideration and doing the intellectual spadework to make sure that a given design is actually going to yield useful information about the question of interest, and then determining what set of statistical analyses you are going to use to get valid conclusions out of a very noisy system with small effect sizes (in the case of psychology, at least; obviously physicists don't have that issue as often). That is the hard part of science.

A study comparing two chemo regimens, while frequently logistically complicated, is intellectually straightforward once you have determined what your outcome measures are going to be.
 
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In psychiatry, our outcome measures are terrible. We try to validate things, but in depression, getting half better is success. In schizophrenia, getting 25% better is success, and in dementia, getting worse less quickly is the goal. I wish I had a nickel for every time I heard that “very soon, we will have a diagnostic test, or very soon, functional imaging will give use the answers we need to understand mental illness, or very soon, the human genome project will cure everything.” I believe in evidence based medicine, but we will always have many more questions than answers.
 
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In psychiatry, our outcome measures are terrible. We try to validate things, but in depression, getting half better is success. In schizophrenia, getting 25% better is success, and in dementia, getting worse less quickly is the goal. I wish I had a nickel for every time I heard that “very soon, we will have a diagnostic test, or very soon, functional imaging will give use the answers we need to understand mental illness, or very soon, the human genome project will cure everything.” I believe in evidence based medicine, but we will always have many more questions than answers.

One of the many, many things that attracts me about psychiatry is that this sort of very basic thing is still up for grabs.
 
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Yikes, Leo, didn't mean to strike a nerve there!

Residency programs are apprenticeship-based. See one, do one, teach one. That is the epitome of an apprenticeship model. Most people will make it through medical school and residency without ever designing and executing even a straightforward experiment. Many will not develop a piece of original research.

This is not really a criticism. Residency is not meant to train researchers. Residency is meant to train clinicians. There are exceptions, of course. There are things like the research track. But this is the exception to the rule.

Residency training can learn quite a bit from the way PhD programs are structured and emphasize conducting research and applying the scientific method. We have made some progress, but not nearly enough.



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And I disagree that the average medical student is less knowledgable about "doing science" than a psychology student since all medical schools in the USA place a huge emphasis on science research. I was on the admissions committee of a prestigious medical school so I do happen to know this.

I'm insulted by your claim that we medical residents amount to people memorizing information.

Clearly you're not in medicine. The complexity and mental challenge of managing, say, a very sick patient in the ICU involves a high level of intelligence to synthesize tons of information that's changing by the day if not the hour, understanding the physics of pulmonology to manage ventilation machines, thinking about how 10 or 15 medications interact with each other (this alone requires processing prowess), and then incorporating the interventions of other specialists like cardiology, infectious disease, etc, to all work together to bring about better health for the patient. It's the most complex form of work imaginable and it goes 100 miles beyond "memorizing" information.

You're like the rest of the people "on the outside". Nobody will understand the science, complexity, and demand of treating complex patients unless they actually do it.

Going to have to agree with others that medical school and the research that most MDs have done provides almost no training in science per se. It provides excellent synopsis of the most commonly accepted scientific theories for how the body works. Yes, you really have to understand how to synthesize the knowledge of best theories to provide patient care and that is an incredibly intellectual and thoughtful process. However, that's not "doing science." When you ask an MD how ___ syndrome works, you'll get a great pathophys explanation. When you ask why exactly we believe that that is the mechanism, you usually get a less satisfying answer.

Personally, I think that the MD is the route to go for providing care, but it doesn't touch a PhD (from a good school) in terms of *science* (the empirical acquisition of knowledge). And frankly, MDs are much easier to complete than PhDs.
 
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And frankly, MDs are much easier to complete than PhDs.

Why even get into that argument? Complete apples to oranges scenario. Would many MDs struggle to get a PhD in a STEM field at a top university? Absolutely. Would many PhDs loose sphincter control prepping for/taking STEPS/Boards? Most definitely.

Certainly getting an MD isn't a gravy train cho cho ride or all these brilliant PhD folks would have taken the "easier" path and made 2-10x the income. Unless you want to tell me all PhDs are just in it for the love of knowledge/science.
 
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We did do a couple of multiple choice tests during the doctoral program. Of course, I have a PsyD so not a heavy research program. I would say that the research experience and competency of psychologists has quite a bit of variability. I probably am more acquainted and comfortable with research than the average PsyD and I don't know how that compares to med students or residents or MDs. The average PhD psychologist is going to have much more expertise in this arena than myself. The more research-focused psychologists are the driving force behind much of the research in this field and wise psychiatrists rely on that information in addition to the studies run by the pharmaceutical companies to get FDA approval. Now if you are talking about the PsyDs from a lower tier professional school, they are a problem and I have run into some who did not even understand the concept of statistical significance.
 
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Man, people get touchy on the "which is harder" thing. Why not just assume that people are doing what they want to do for a career. If we want to look at the actual numbers, there is no statistical difference in IQ between MD's and PhDs. And, after 75k, there is no incremental increase in happiness when other factors are controlled for.

As for the research thing. Yeah, that would indeed be a strength of PhD training. I frequently have to explain somewhat basic psychometrics to other providers in discussing my evaluations. I also get incredulous looks when I do presentations to residents about how certain medications really don't work (e.g., Aricept).

All in all, it is kind of apples and oranges, why do we even need to compare? They're different jobs, and many of us wouldn't do the other job no matter how much they paid.
 
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What is the lingering uneasiness about prescribing? As a psychologist who primarily does psychotherapy, I am relieved that I don't have to deal with the issues that a psychiatrist has to deal with as the holder of the prescription pad and the "magic pill". On the other hand it is disappointing that I cannot directly help patients who can greatly benefit from appropriate medications. Especially when it takes more than a few months to get into see a psychiatrist and in the meantime the PCP wants to know from me what they should prescribe and what dosage to initiate.

If I had to do it all over again, I really don't know which route I would take, but the biggest reason of all that makes me doubt my decision is money. Even the lowest paid full-time psychiatrist makes substantially more than me and I am in the 90th %ile of psychologists. I love being a psychologist and will brag about what we bring to the table all day long, but if I was a psychiatrist, I would easily have double the income.
What you've described is basically how I feel about the situation. I think that with a thorough understanding of how the medicines work and when they are best used, not to mention taking the time to keep up with current information, would make me more confident about medicating patients. I also (maybe selfishly) want the best of all sides; prescribe medicine to those who need it, use psychotherapy for other situations, and bring home the hefty paycheck of a psychiatrist (which isn't my top priority, but it's still important). Do you think that if you had to do it all over again that you might go the psychiatry route but go through some psychotherapy training, too? Or is that still too far removed from what you do now?
 
When I have voiced my regrets about not pursuing the path of psychiatry, my wife insists that I have made the right choice for myself even though she wouldn't mind double the money. She is my best source of objective appraisal on what would make me most fulfilled and satisfied with life. She sees the passion with which I talk about my work and the field of psychology so she knows that there are really no regrets. My goal these days is to work towards increasing the compensation of all psychologists. One reason I enjoy being on the psychiatrists board is they appear to have a bit more economic sense than many of the psychologists that I have known.

Also, I wanted to add that these are entirely subjective statements of personal observations and are not firmly rooted in empiricism. :p
 
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When I have voiced my regrets about not pursuing the path of psychiatry, my wife insists that I have made the right choice for myself even though she wouldn't mind double the money. She is my best source of objective appraisal on what would make me most fulfilled and satisfied with life. She sees the passion with which I talk about my work and the field of psychology so she knows that there are really no regrets. My goal these days is to work towards increasing the compensation of all psychologists. One reason I enjoy being on the psychiatrists board is they appear to have a bit more economic sense than many of the psychologists that I have known.
It's great that you're so passionate about your field (and that your wife can see that and remind you of it during those conversations). Increasing compensation of all psychologists seems like a worthwhile goal, too :)

And personal observations are still useful!
 
Man, people get touchy on the "which is harder" thing. Why not just assume that people are doing what they want to do for a career. If we want to look at the actual numbers, there is no statistical difference in IQ between MD's and PhDs. And, after 75k, there is no incremental increase in happiness when other factors are controlled for.

As for the research thing. Yeah, that would indeed be a strength of PhD training. I frequently have to explain somewhat basic psychometrics to other providers in discussing my evaluations. I also get incredulous looks when I do presentations to residents about how certain medications really don't work (e.g., Aricept).

All in all, it is kind of apples and oranges, why do we even need to compare? They're different jobs, and many of us wouldn't do the other job no matter how much they paid.

The only reason to get into it at all is that if the OP enjoys doing original research and being scientifically as rigorous as possible, a PhD in psychology is probably a better route than a straight-up MD. No argument about them being totally different routes that both require performing tasks of significant, if radically different, cognitive complexity.

Why even get into that argument? Complete apples to oranges scenario. Would many MDs struggle to get a PhD in a STEM field at a top university? Absolutely. Would many PhDs loose sphincter control prepping for/taking STEPS/Boards? Most definitely.

Certainly getting an MD isn't a gravy train cho cho ride or all these brilliant PhD folks would have taken the "easier" path and made 2-10x the income. Unless you want to tell me all PhDs are just in it for the love of knowledge/science.

My first-pass theory of "who goes in for PhDs" would recognize four basic groups:
1. People who are incredibly passionate about research in their field
2. People who really enjoyed a particular subject in undergrad and did not do sufficient homework to realize that being a graduate student is a radically different proposition
3. People who are generally smart but aren't particularly driven in a strong direction and go into it because it is usually paid and puts off having to pursue a less structured career
4. People who have an established career path who need a terminal degree for prestige/institutional reasons.

I don't think it has much to do with who is "smarter" in some poorly-defined domain-general way. I realize that yes "g" is a measurable thing but I am still deeply skeptical of intelligence without respect to a particular kind of cognitive task.
 
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Medicine requires some critical thinking, but come on look at the Step exams, which are really the most challenging "intellectual" aspects of medicine. You have to spend at most 30 seconds-1 minute to come up with a solution. What kind of critical thinking is that? At best, it's about pattern recognition and integrating evidence from multiple sources to come up with the most probable explanation. Most of medicine is about knowing your facts. Science demands far more critical thinking and much more creativity, obviously. Having said that, I wouldn't be surprised if MDs are on average more intellegent than PHDs. It's much easier to get into graduate school, and you can still get a PhD by latching on a project already set up for you and doing all the monkey work.
 
Having said that, I wouldn't be surprised if MDs are on average more intellegent than PHDs. It's much easier to get into graduate school, and you can still get a PhD by latching on a project already set up for you and doing all the monkey work.

There is actually data on this. Spoiler alert, there are no differences. As for what is "harder" to get into, I'd say the answer is, it depends. Can most people get into a diploma mill like Argosy? Sure. On the flip side, can most people get into a shady Caribbean med school, sure. When you look at reputable programs in both fields, you're still looking at acceptance rates <5%.
 
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Psychologists could earn the same as psychiatrists, but they would have to do what medical schools do; clamp down on the numbers up stream of Grad school. Sure there are some for profit international med schools that are easier to get into, but it isn’t likely they will get into training and license. Psychologists have multiple unaccredited diploma mills and an infinite amount of unemployed psychologists who will do your job for less money.
 
Psychologists could earn the same as psychiatrists, but they would have to do what medical schools do; clamp down on the numbers up stream of Grad school. Sure there are some for profit international med schools that are easier to get into, but it isn’t likely they will get into training and license. Psychologists have multiple unaccredited diploma mills and an infinite amount of unemployed psychologists who will do your job for less money.

I'm with you on this one. Our APA will seemingly give out accreditation as long as someone sends in the right amount of Lucky Charm's box tops. Luckily we generally keep the riff raff out of the more lucrative positions, but those are more reputation based, like forensics, where the ceiling on earnings is quite high.
 
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There is actually data on this. Spoiler alert, there are no differences. As for what is "harder" to get into, I'd say the answer is, it depends. Can most people get into a diploma mill like Argosy? Sure. On the flip side, can most people get into a shady Caribbean med school, sure. When you look at reputable programs in both fields, you're still looking at acceptance rates <5%.

Well I have to disagree. It's much easier to get into a reputable grad school than a med school. Acceptance rate isn't the whole story. You have to look at the pool. (and as a notice, I'm not talking about clinical psychology doctoral programs, but those in the biological sciences and psychology). Then again, it's important to keep in mind that they are also going for very different metrics. One of the most ironic processes about admissions is that the MCAT is a much better assessment of science-related critical thinking than GREs (which are pretty much a joke. They changed in the last 2 years I think, but they were still a joke a few years ago). That's why MD/PhD admissions don't care about the GRE.
 
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Well I have to disagree. It's much easier to get into a reputable grad school than a med school. Acceptance rate isn't the whole story. You have to look at the pool. One of the most ironic processes about admissions is that the MCAT is a much better assessment of critical thinking than GREs (which are pretty much a joke. They changed in the last 2 years I think, but they were still a joke a few years ago). That's why MD/PhD admissions don't care about the GRE.

Well, I have to disagree with your disagreement. First, by what measure are you using to back up your assertion that the MCAT is a better "critical thinking" test? It's largely besides the point, though. In reputable PhD's, the GRE's are pretty much just a simple grouping variable. You need to be above a certain number to just get considered. After that, it's pretty much other variables which carry the day, such as research experience (presentations, publications, writing ability, etc). I don't think either is really "easier" than the other, they take different skillsets and preparation, sure. But I think you'll be hard pressed to "prove" which is "harder."
 
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Well, I have to disagree with your disagreement. First, by what measure are you using to back up your assertion that the MCAT is a better "critical thinking" test? It's largely besides the point, though. In reputable PhD's, the GRE's are pretty much just a simple grouping variable. You need to be above a certain number to just get considered. After that, it's pretty much other variables which carry the day, such as research experience (presentations, publications, writing ability, etc). I don't think either is really "easier" than the other, they take different skillsets and preparation, sure. But I think you'll be hard pressed to "prove" which is "harder."

I did both so I kinda understand the type of reasoning involved, and as I mentioned, MD/PhD programs place a big importance on MCATs and don't bother to look at GREs. That has to tell you something. The majority of accepted graduate students even to top programs don't have a significant publication record. Most of them have research experience and you will stand out already if you managed to do anything independently at the undergraduate stage, even if not published. In any case, I didn't mean to step on anyone's toes, but I think it's pretty much accepted that medical school admissions are much more rigorous and competitive than acceptance to graduate schools.
 
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Forgive me for not accepting an anecdote as definitive evidence. I prefer data. Granted, this is a difficult thing to measure, especially since we're trying to equalize two different systems. But, I don't think it's a given at all. I haven't seen any data that would suggest it is.
 
the chair of psychiatry at my medical school used to explain the difference between psychologists and psychiatrists as "psychologists are more intelligent but psychiatrists are better paid". this was in the UK where we don't have a mass proliferation of shady programs and it is highly competitive to get into a DClinPsy program, much like a PhD clinical psychology program in the US.
 
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Why even get into that argument? Complete apples to oranges scenario. Would many MDs struggle to get a PhD in a STEM field at a top university? Absolutely. Would many PhDs loose sphincter control prepping for/taking STEPS/Boards? Most definitely.

Certainly getting an MD isn't a gravy train cho cho ride or all these brilliant PhD folks would have taken the "easier" path and made 2-10x the income. Unless you want to tell me all PhDs are just in it for the love of knowledge/science.

I was speaking from my personal experience and that of most of the people that I know with or working on both degrees. Getting into med school was harder than (non clinical) PhD, no question. Completing the phd was harder in every way.

I wasn't trying to start a flame war, just giving some personal experience in the context of someone stating that medical training teaches "science," which I argue that it does not at all in the true sense of the word. I also think that many MDs are quite dismissive of their phd colleagues and really don't have a fair conceptualization of what it takes to make a truely novel contribution to a field. Some make awesome researchers... but I'd challenge you to find someone who'd hire any new MD over a new PhD to be a post doc on their only R01.
 
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the chair of psychiatry at my medical school used to explain the difference between psychologists and psychiatrists as "psychologists are more intelligent but psychiatrists are better paid". this was in the UK where we don't have a mass proliferation of shady programs and it is highly competitive to get into a DClinPsy program, much like a PhD clinical psychology program in the US.
lol. If we were more intelligent then maybe we could figure out a way to make more money! Of course, I am being a bit silly about it on a Friday night. After all, IQ is a poor predictor of earning potential and within any field we don't often see the cream of the intellectual crop rise to the top. I'm just glad that I have good social and emotional skills to go along with a good ability to process, store, and retrieve data. It gives me a chance to make a pretty good living. Now if only I could play guitar...
 
Psychologists could earn the same as psychiatrists, but they would have to do what medical schools do; clamp down on the numbers up stream of Grad school. Sure there are some for profit international med schools that are easier to get into, but it isn’t likely they will get into training and license. Psychologists have multiple unaccredited diploma mills and an infinite amount of unemployed psychologists who will do your job for less money.

OK, this might be my hobby horse now, but there are ever growing psychiatric NP programs (including online). In states with independent practice NPs, I can't see that doing anything but lowering income for all of us.
 
Just to put it in perspective, before there were NPs, the majority of psychotropic medications were being written (badly) by primary care / GP/ family medicine docs. We have so underserved the market, the vacuum has created NPs and the like. Most of them do little more than meds so don't feel threatened. Last I checked, primary care docs don't particularly like doing psych meds. Their idea of integration of care is to want a phone number that can be used to get their patients to a psychiatrist. We have under saturated this market enough, and having others fill in will not satiate the population's desire to have more of us that much. This has been true since Thorazine was marketed in 1958. :nod:
 
Just to put it in perspective, before there were NPs, the majority of psychotropic medications were being written (badly) by primary care / GP/ family medicine docs. We have so underserved the market, the vacuum has created NPs and the like This has been true since Thorazine was marketed in 1958. :nod:
The historian here has to point out that Thorazine was first marketed in the US by SmithKline & French in 1954
 
Contra your assertions that I am "clearly not in medicine", I am in my 4th year of medical school. 1st and 2nd years were spent with lecture after lecture of bald assertions of facts as more or less arbitrarily true. There is very good reason for that - above all students must be prepared these days for board exams - but there wasn't even a scintilla of the critical thinking one gets in a first-year seminar of your average academic graduate program. Some of those facts happened to be related to each other in a structured way, but perhaps with the exception of renal physiology, it was a structure built on "these things appear to be true-ish statements about the world, you need to know them to do useful things." Medical school is much better understand as a kind of trade/professional school than graduate school in the traditional sense. One giveaway that reasoning and careful interpretation of empirical data is not really the main object of instruction: medical school exams are overwhelmingly multiple choice tests.

I will pay you cash money if you can find a PhD scientist who took a multiple choice test of any kind during graduate school as part of their coursework.

So far as your ICU example is concerned, of course it is difficult! It is a complex engineering problem that requires a high degree of proficiency in summarizing a large body of information in a useful fashion and manipulating simple mathematical models of a complex system in real time. It clearly requires a high degree of precision and processing. So does playing chess, as the literally thousands of volumes of chess theory attest, many of which focus exclusively on the first half dozen moves of the game. Neither of them is science, although in the ICU case you are of course using a large body of facts that were ultimately derived via scientific methods.

Med students acting as lab monkeys does very little to invalidate this point. Sure, some people with MDs do science. But it was not because their MD curriculum taught them anything about how to do that. I don't know what you think a "basic psychological study" is, but frequently the tricky part is not in the design itself, but determining what would constitute a legitimate test of a hypothesis under consideration and doing the intellectual spadework to make sure that a given design is actually going to yield useful information about the question of interest, and then determining what set of statistical analyses you are going to use to get valid conclusions out of a very noisy system with small effect sizes (in the case of psychology, at least; obviously physicists don't have that issue as often). That is the hard part of science.

A study comparing two chemo regimens, while frequently logistically complicated, is intellectually straightforward once you have determined what your outcome measures are going to be.

You pretty much said everything I was going to say. I've learned much more about the scientific process in my first four months of grad school than I did in two years of medical school. Actually, to hammer home your points even further, I learned more about stats and research design in my corresponding undergrad classes (psych major- we had a required stats class and a required methods class in our department) than I did in my first two years of med school.
 
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  • I'll get to combine helping people with a thorough understanding of how the body works
  • I'd still get to practice psychotherapy if I complete a program for it
  • I'm interested in health, but I find the brain to be particularly interesting
  • Psychiatry seems more science-based, provides more job stability, and is in high demand
  • I'm far more interested in practice than research
  • I'm willing to dedicate several years to schooling
  • I'd enter the workforce sooner
  • The hours seem flexible and manageable, and the pay is much better than psychology

The job security, flexibility, and pay are great advantages of psychiatry, as is the ability to use multiple modalities of treatment. If you want to have a primarily clinical career in a mental health field, psychiatry will afford you the greatest breadth and the highest compensation. It's true that psychiatry trainees earn meaningful money sooner in their careers, but taking on debt seems inevitable. At a funded Ph.D. program you would receive a stipend that is just (barely) enough to live on, as well as tuition remission, so you can technically go to school for little or no money if you budget wisely. Even so, earnings-wise even counting debt you'll make way more in full-time psychiatry than in psychology.

You seem to overestimate the current state of knowledge regarding how the brain "works" and the evidence base to support psychiatric treatments. The behavioral psychotherapies in fact have some of the strongest scientific foundations - you can trace them all the way back to learning theory and they still hold up well through the lens of cognitive neuroscience. Academic psychiatrists and psychologists conduct research on mental disorders and treatments and it's not always easy to tell the disciplines apart in research settings. For example, my advisor in graduate school ran drug trials out of our lab in a psychology department, and I was mentored by a psychiatrist whose research program focused mainly on behavioral management and care coordination.

I chose to pursue a Ph.D. in psychology when it became clear to me that research was my passion. I've been happy with my decision. However, if you're interested in a mainly clinical career you are right to seriously consider psychiatry.
 
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You seem to overestimate the current state of knowledge regarding how the brain "works" and the evidence base to support psychiatric treatments. The behavioral psychotherapies in fact have some of the strongest scientific foundations - you can trace them all the way back to learning theory and they still hold up well through the lens of cognitive neuroscience. .

Hear hear. Neuroimaging studies that have even a single conclusion that could not have been demonstrated equally well through careful behavioral experimentation are few and far between.
 
But never turn in a grant without functional imaging or you will be a heretic. :nono:
 
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I'm not talking about setting up a simple research study. Psychological studies are some of the most straight-forward studies I've ever seen. Try setting up a basic science study, or a research study on cancer medicine, or a biomedical engineering research study. Most, and I mean most, med students have been actively engaged in scientific research, and on a more complex level than a psychological study.

And I disagree that the average medical student is less knowledgable about "doing science" than a psychology student since all medical schools in the USA place a huge emphasis on science research. I was on the admissions committee of a prestigious medical school so I do happen to know this.

Oh man, you are so wrong about this! My research training in the first semester of my Psych masters degree alone blows medical school research training out of the water. There wasn't a multiple choice test in sight. A PhD is about depth. Medical education is about as deep as an ash tray.

I learned three programming languages, collaborated across state and international boundaries, finished assembling twenty years of research under my research mentor (over 1500 participants, of which I added roughly 300), and went far beyond multivariate statistics into computational modeling to complete my thesis (published here for reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115037/).

After my degree I got an industry job in artificial intelligence working with Psych PhDs who dissect the inner workings of social media and monitor your phone calls in their spare time just for fun.

But oh, you were on the admissions committee of a prestigious medical school so you must know what you're talking about. What a joke. Pull your head out of your prestigious anal sphincter.
 
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The job security, flexibility, and pay are great advantages of psychiatry, as is the ability to use multiple modalities of treatment. If you want to have a primarily clinical career in a mental health field, psychiatry will afford you the greatest breadth and the highest compensation. It's true that psychiatry trainees earn meaningful money sooner in their careers, but taking on debt seems inevitable. At a funded Ph.D. program you would receive a stipend that is just (barely) enough to live on, as well as tuition remission, so you can technically go to school for little or no money if you budget wisely. Even so, earnings-wise even counting debt you'll make way more in full-time psychiatry than in psychology.

You seem to overestimate the current state of knowledge regarding how the brain "works" and the evidence base to support psychiatric treatments. The behavioral psychotherapies in fact have some of the strongest scientific foundations - you can trace them all the way back to learning theory and they still hold up well through the lens of cognitive neuroscience. Academic psychiatrists and psychologists conduct research on mental disorders and treatments and it's not always easy to tell the disciplines apart in research settings. For example, my advisor in graduate school ran drug trials out of our lab in a psychology department, and I was mentored by a psychiatrist whose research program focused mainly on behavioral management and care coordination.

I chose to pursue a Ph.D. in psychology when it became clear to me that research was my passion. I've been happy with my decision. However, if you're interested in a mainly clinical career you are right to seriously consider psychiatry.
Thanks for the thorough reply! It's good to know that my impression of psychiatry is at least somewhat accurate :) I still want to take a while to compare the pros and cons, but (as of now) I'm willing to take on the debt for med school. I'm also looking into the NHSC scholarship, although that's a whole other conversation!

I assumed that there was still a measure of ambiguity in how the brain works, so I'm fairly comfortable with that. In fact, I hope that it makes me more discerning when choosing to/not to prescribe medication. It's interesting to read the overlap you've described between the fields; that research must be vigorous work. Are you currently doing any right now?

Research doesn't seem up my alley, but I hope to give it a try sometime next year. Up until now I've been focused on practice (whether with psychology or psychiatry). What experience(s) let you know that research was right for you?
 
Research doesn't seem up my alley, but I hope to give it a try sometime next year. Up until now I've been focused on practice (whether with psychology or psychiatry). What experience(s) let you know that research was right for you?

It's a good idea to volunteer as a research assistant to get a little taste of what research entails. Even if you're not interested in conducting research yourself, you should be familiar with how evidence is generated. As a practicing physician or a psychologist you will be a consumer of research.

Though I loved my stats and research design courses in college, it was really the practical, hands-on experience that sold me on research. I first worked in a behavioral neuroscience lab in which the PI was studying an animal model of a developmental disorder. I did that for about a year and found that I had both good technical skills (I didn't accidentally kill any rats, unlike everyone else in the lab including the PI!) and a taste for reviewing the literature, generating hypotheses, and collecting data. However, I decided that I really wanted some experience in human subjects research, so after that first year I switched labs and assisted with several studies using various methodologies (psychophysiology, interview/survey, etc.). I took on more and more responsibilities and the faculty member running the lab eventually hired me as an employee. By that point I had mostly made up my mind. I worked full time (in another setting as a data analyst) for another year and then took the plunge into graduate school. My program followed the clinical scientist training model and therefore was very research intensive (though we also still learn clinical assessment and psychotherapy beginning in the first year). I had published 8 journal articles and a handful of book chapters by the time I received my Ph.D. However, there are more balanced programs that give more time and emphasis to clinical training.
 
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