aggiecrew said:
sorry if this comes off as a dumb question but I'm just learn more about this issue so here goes..
I have kinda always been under the impression that a psychiatrist and a psychologist were pretty much out to treat the same kinds of patients and study the same subjects, it was just that psychiatrists had an M.D. and could prescribe meds and a psychologist was a PhD and could not prescibe meds.
Now from reading these boards it seems like pyschiatrists spend a substantially larger portion of their time adjusting medication than time on things like say marriage counseling for example, which I assumed before was handled by both professionals.
Is there sort of an expectation that because a psychiatrist CAN spend most of their time adjusting meds that they SHOULD spend most of their time on meds and less on counseling (leaving that to psychologists and master's degree level therapists)?
Does this extend to the expected research interests of an academic psychiatrist versus an academic psychologist? i.e. the academic psychiatrist would be expected to study meds and not things like behavioral theory and relationship theory?
I hope that makes sense, I can try to clarify if need be.
Any insight you could give would be GREATLY appreciated.
thanks
OK, here's the rundown, based on my experience as a psychiatrist and what I know from my friends who are psychiatrists and psychologists. Psychiatrists can prescribe medications and diagnose and treat medical conditions as well as psychiatric conditions, which psychologists cannot do. Psychologists, on the other hand, can do psychological and neuropsychological testing, which psychiatrists cannot do. They have a somewhat different bias with regard to patient assessment. Psychologists tend to (and this is a generalization) initially focus on patients' strengths and coping skills more than their pathology or specific diagnosis. Psychiatrists, like other doctors, tend to focus on pathology and diagnosis first, before exploring the patient's strengths. Both approaches have their positives and negatives.
Both psychologists and psychiatrists can do psychotherapy. On average, a psychologist receives more training in theory -- including, for example, social psychology and industrial psychology as well as human development -- than a psychiatrist does. However, the amount of time spent doing supervised psychotherapy in training for both psychologists and psychiatrists may be comparable. Psychiatrists begin doing individual psychotherapy by their 2nd year in almost all programs; psychologists may not do so until their externships. However, how much of the time with patients in a residency program is psychotherapy vs. psychopharmacology varies quite a bit from program to program.
Psychiatrists certainly can and do perform psychotherapy with patients, including individual, couple, and group therapy. However, few psychiatrists have spent as much time during their residency as most psychologists have in their training doing group and couples therapy. (Again, it varies depending on the program.) So, the psychiatrists who do that often do electives in those areas or train further after residency, or they just start doing it with less training at first and gain clinical experience over the years, like all therapists do. There is no "inherent" difference in who "should" do those areas; it is more common for psychologists to do so. In general, once a person has been doing psychotherapy of any kind for years, if they have enough good basic training to begin with -- a Ph.D. or M.D. -- they are basically indistinguishable from one another.
As for doing psychotherapy vs. psychopharm, well, the pressure is usually internal. You can usually make more money seeing patients for psychopharm visits, since insurance companies usually don't pay significantly more for psychotherapy visits, which take significantly longer. For example, an insurance company might pay $75 for a med visit that takes 20 minutes (or less, depending on how quick the doc is and what sort of care they like to give), and $100 for a psychotherapy visit that takes 45 minutes. Do the math, and you can see why some psychiatrists choose to do med visits only. The insurance companies do this because they know they can then send the patient to a less-trained person for psychotherapy, which will cost less. However, it is a rare situation where a psychiatrist *cannot* do psychotherapy. It is a choice. I choose to do psychotherapy for the majority of my days because I enjoy it, though I also do enjoy seeing patients with complex medication issues. Money is not everything.
As you might notice from the above paragraph, however, psychologists are getting squeezed out of the market as insurance companies drop rates for psychotherapy lower and lower. It is patently absurd to lump Ph.D. psychologists in with social workers and masters-level psychology degrees, but to insurance companies, they all look like therapy "providers." That's a whole other topic.
In academia, anything goes. You certainly could, as a psychiatrist, study behavior theory, or anything else. However, most people end up doing research with mentors they meet during training. MDs tend to meet MDs, relatively fewer of whom are doing that sort of research. Plus, since psychiatrists are MDs and enjoy "hard" science, there is a wide variety of really interesting biological, neurological, or pharmacologic research going on that can easily draw them away. But, many psychiatrists do in fact do clinical research on a wide variety of psychotherapies, not just medications. Obviously, you won't get the huge grant money, but like I said, money isn't everything.
Well, I hope this helps. I've tried to give an honest account, but any psychologists lurking about (and I know there are a few <g>) who want to step up and correct me, please feel free.
CORRECTION:
I have been told that psychologists are, in fact, generally tossed into rooms with clients -- which is exactly how it feels to all MD & PhD trainees when they start doing individual therapy! -- in their very first year of graduate school, before they do their externships starting in their second year. Mea culpa.
