MD in psychiatry vs. PhD in psychology to become a therapist?

[UnicornDemon]

One of my dream jobs was to grow up and become a therapist. I'd love to listen to people's problems, decipher how those problems arise, and help them through it. I almost feel as though I'd have a passion for the career. I want to be like Paul Weston from In Treatment. However, I often come across doom and gloom posts on these forums from people who spent years of their lives in a PhD program only to end up in a low paying job due to market saturation.

From what I understand, psychiatrists are capable of enrolling in residencies which train them in psychotherapy. So as a psychiatrist I would still be able to practice therapy. Unfortunately, I would have to endure four years of medical school hell before beginning residency. Not only that, but training and education in psychology/therapy would be minimal. Still, job prospects and salaries are much higher for psychiatrists, so if I ever find that doing what I love isn't worth years of hard work for low income, I always have the option of selling out and becoming a pill pusher.

So, what would you recommend, a career as a Psychiatrist or a PhD in psychology?

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[PHD12]

One of my dream jobs was to grow up and become a therapist. I'd love to listen to people's problems, decipher how those problems arise, and help them through it. I almost feel as though I'd have a passion for the career. I want to be like Paul Weston from In Treatment. However, I often come across doom and gloom posts on these forums from people who spent years of their lives in a PhD program only to end up in a low paying job due to market saturation.

From what I understand, psychiatrists are capable of enrolling in residencies which train them in psychotherapy. So as a psychiatrist I would still be able to practice therapy. Unfortunately, I would have to endure four years of medical school hell before beginning residency. Not only that, but training and education in psychology/therapy would be minimal. Still, job prospects and salaries are much higher for psychiatrists, so if I ever find that doing what I love isn't worth years of hard work for low income, I always have the option of selling out and becoming a pill pusher.

So, what would you recommend, a career as a Psychiatrist or a PhD in psychology?

I see your conflict. How about looking into an MSW program at a good state school to reduce cost? LCSW's practice psychotherapy and are hired more often as therapists compared to psychologists. Cons: generally low salary and most therapists have pretty bad working conditions because of the way health care is run these days, such as high case loads and inability to see patients regularly (this is the case for both PHD and PsyD graduates too if they have a 100% clinical role in many settings). However, if you are okay with living simply in a low cost of living location, this can work. Also, the VA tends to have good working conditions for therapists overall compared to most other settings.

Another option is NP in psychiatry. Only 3 years of training so significantly better than psychiatry and psychology. From talking to NP's, the curriculum is more interesting/integrative than medical school, which focuses on memorizing more. Pros: higher salary than both MA therapists and PsyD/PhD therapists. Cons: you will still have to prescribe medication.

I don't think the PhD is a good fit if you want "only" want to be a psychotherapist. It's going to be 7-8 years of training and you will have to do research, often master's thesis, and dissertation. This is going to be painful if you don't enjoy research. PsyD also requires a dissertation, but is too costly unless you get into the 2 or so PsyD programs that have good outcomes are are affordable. Plus, as I mentioned, the way our health care system is run it is not a pleasant place to be in a 100% psychotherapist role, and most cannot practice according to high standards at hospitals. Plus, therapists on the doctoral level tend to have some of the lower incomes compared to psychologists who also do testing, research etc.

In terms of psychiatry, i'm not sure why you are calling it hell. How much do you know about the education and curriculum?

In treatment is also not a good characterization of what therapy is really like.

Good luck!

 

[Therapist4Chnge]

I want to be like Paul Weston from In Treatment.

While the first season of "In Treatment" is probably one of the better portrayals of the day-to-day work of someone who primarily does psychotherapy, it misses the mark in some areas. Being able to speak to different providers (LCSW, Ph.D., M.D., etc) in your community would probably give you a better idea of the day-to-day work.

However, I often come across doom and gloom posts on these forums from people who spent years of their lives in a PhD program only to end up in a low paying job due to market saturation.

There is somewhat of a selection bias on SDN in regard to outcome, so everything should be taken with a grain of salt. Much like a favorite fishing story...the truth is somewhere mixed into the re-telling by the fisherman, the friends, and the fish.

 

[ForHumors]

As a premed student interested in psychiatry, I do have to point out some of the positives to considering psychiatry. You are right, it is in demand. I am currently doing an internship in a psychiatric hospital and learned the average age of psychiatrists in the US is ~55. Its an aging population and the demand for psychiatrists is only going to increase. Personally, I like the idea of being a psychiatrist because of the greater treatement options opened to me. I do not want to be a "sell out pill-pusher" but I will have the option of using medication, therapy, other interventions such as ECT and potentially TMS, or a combination of those options (when there is research to support doing so, like D-cycloserine. Its pretty cool stuff, check it out). I am disappointed there isn't more of an emphasis on learning psychology in medical school, but I believe I am motivated to do so myself in other ways.

However,you are right that getting through premed and med school could be difficult, particularly if you have little interest in the subject material. If you don't have more than a passing interest in biology and chemistry, med school might not be right for you. I used to not have that much of an interest in them, but since then I have learned to love them and love the connections I can make between my psychology, biology, and chemistry classes.

 

[Therapist4Chnge]

However,you are right that getting through premed and med school could be difficult, particularly if you have little interest in the subject material.

The same can be said about psychology and research. Whether a person goes on to a career in academia/private practice/other...research is important. You need to do it as an undergrad to be competitive for grad school, then you need it in grad school to inform your intervention work, and finally you need to continually use it (e.g. read journal articles about new/better interventions) in practice so that you can be an effective clinician.

 

[ForHumors]

The same can be said about psychology and research. Whether a person goes on to a career in academia/private practice/other...research is important. You need to do it as an undergrad to be competitive for grad school, then you need it in grad school to inform your intervention work, and finally you need to continually use it (e.g. read journal articles about new/better interventions) in practice so that you can be an effective clinician.

Good point... hopefully the OP will stay up to date on the research no matter what route he/she enters the mental health field through, whether it be MD, PhD, PsyD, LCSW, RN, etc. If research isn't your cup of tea, a PhD program would be a pretty tough time.

 

[UnicornDemon]

I see your conflict. How about looking into an MSW program at a good state school to reduce cost? LCSW's practice psychotherapy and are hired more often as therapists compared to psychologists. Cons: generally low salary and most therapists have pretty bad working conditions because of the way health care is run these days, such as high case loads and inability to see patients regularly (this is the case for both PHD and PsyD graduates too if they have a 100% clinical role in many settings). However, if you are okay with living simply in a low cost of living location, this can work. Also, the VA tends to have good working conditions for therapists overall compared to most other settings.

Another option is NP in psychiatry. Only 3 years of training so significantly better than psychiatry and psychology. From talking to NP's, the curriculum is more interesting/integrative than medical school, which focuses on memorizing more. Pros: higher salary than both MA therapists and PsyD/PhD therapists. 1. Cons: you will still have to prescribe medication.

2. I don't think the PhD is a good fit if you want "only" want to be a psychotherapist. It's going to be 7-8 years of training and you will have to do research, often master's thesis, and dissertation. This is going to be painful if you don't enjoy research. PsyD also requires a dissertation, but is too costly unless you get into the 2 or so PsyD programs that have good outcomes are are affordable. Plus, as I mentioned, the way our health care system is run it is not a pleasant place to be in a 100% psychotherapist role, and most cannot practice according to high standards at hospitals. Plus, therapists on the doctoral level tend to have some of the lower incomes compared to psychologists who also do testing, research etc.

3. In terms of psychiatry, i'm not sure why you are calling it hell. How much do you know about the education and curriculum?

4. In treatment is also not a good characterization of what therapy is really like.

Good luck!

1. I wouldn't really mind prescribing medications as a psychiatrist, even though I know how ineffective they are. I just wouldn't want to be a psychiatrist that meets with his patients for only fifteen minutes, gets a brief background of the patient's history, and hands out medication as if it's candy.

2. Well, I hope this doesn't come across as arrogant but I'm a fairly ambitious person, and I feel as though I'd sell myself short by going for an NP in psychiatry. I have very little social life, so I would not be sacrificing much to pursue the PhD. It'd also be kind of embarrassing to go by the title of nurse considering how I'm a man- if everyone I knew wouldn't know (family, friends, etc.) I might consider this path, but it just seems a bit demeaning. Besides, wouldn't the research I conduct during my PhD improve my ability to develop insights into my patients and provide them with therapy?

3. I don't know much about the residency in psychiatry itself, but I believe I'd enjoy learning about various mental disorders and their medical treatments. I do not think I would enjoy the first four years of medical school, where I will be constantly pressured to learn every aspect of the human body and medicine in general, and go through sleepless nights in clinical rotations during my third year. See the posts by NYCMS2 in this thread to hear grave warnings against attending medical school: http://forums.studentdoctor.net/showthread.php?t=1018618

4. How so?

 

[Therapist4Chnge]

4. How so?

1. If it were real life then Paul would have a lot more cancellations, more turnover, a ton more paperwork, more issues with payment (even as a $ only practice), countless wasted time sitting in continue education "classes", and a line around the block of friends/acquaintances of his mom's sister's hairdresser/strangers hitting him up for advice.

2. The actual clinical work would be much more (false) start and go, monotonous because certain conditions are far less interesting to treat than others, frustrating because the patient isn't willing to make the necessary changes, difficult because some cases can really hit a nerve, etc.

All of the above makes for a more boring show, so it was understandably curbed or overtly omitted. It isn't all negative, but that is what I remember when I watched the show. Oddly enough, it was also when I was getting burned out working w. high-relapse & low compliance patients....so my perception of therapy and the show may have been biased.

 

[Doctor Eliza]

If you think of medication as ineffective and don't like the idea of med school, I can't imagine that psychiatry is a fit. I'm a psychologist and I'm not quite sure why you are charactierizing medicine in this way, as I have seen it do wonders for my patients.

Do you enjoy research? You didn't mention it and it is a huge part of PhD training.

Where are you in your education at this point?

Dr. E

1. I wouldn't really mind prescribing medications as a psychiatrist, even though I know how ineffective they are. I just wouldn't want to be a psychiatrist that meets with his patients for only fifteen minutes, gets a brief background of the patient's history, and hands out medication as if it's candy.

2. Well, I hope this doesn't come across as arrogant but I'm a fairly ambitious person, and I feel as though I'd sell myself short by going for an NP in psychiatry. I have very little social life, so I would not be sacrificing much to pursue the PhD. It'd also be kind of embarrassing to go by the title of nurse considering how I'm a man- if everyone I knew wouldn't know (family, friends, etc.) I might consider this path, but it just seems a bit demeaning. Besides, wouldn't the research I conduct during my PhD improve my ability to develop insights into my patients and provide them with therapy?

3. I don't know much about the residency in psychiatry itself, but I believe I'd enjoy learning about various mental disorders and their medical treatments. I do not think I would enjoy the first four years of medical school, where I will be constantly pressured to learn every aspect of the human body and medicine in general, and go through sleepless nights in clinical rotations during my third year. See the posts by NYCMS2 in this thread to hear grave warnings against attending medical school: http://forums.studentdoctor.net/showthread.php?t=1018618

4. How so?

 

[ForHumors]

1. I wouldn't really mind prescribing medications as a psychiatrist, even though I know how ineffective they are. I just wouldn't want to be a psychiatrist that meets with his patients for only fifteen minutes, gets a brief background of the patient's history, and hands out medication as if it's candy.

2. Well, I hope this doesn't come across as arrogant but I'm a fairly ambitious person, and I feel as though I'd sell myself short by going for an NP in psychiatry. I have very little social life, so I would not be sacrificing much to pursue the PhD. It'd also be kind of embarrassing to go by the title of nurse considering how I'm a man- if everyone I knew wouldn't know (family, friends, etc.) I might consider this path, but it just seems a bit demeaning. Besides, wouldn't the research I conduct during my PhD improve my ability to develop insights into my patients and provide them with therapy?

3. I don't know much about the residency in psychiatry itself, but I believe I'd enjoy learning about various mental disorders and their medical treatments. I do not think I would enjoy the first four years of medical school, where I will be constantly pressured to learn every aspect of the human body and medicine in general, and go through sleepless nights in clinical rotations during my third year. See the posts by NYCMS2 in this thread to hear grave warnings against attending medical school: http://forums.studentdoctor.net/showthread.php?t=1018618

4. How so?

1) There are some mental disorders where medication is more effective, some where it is less effective. The point is to know when to prescribe vs not prescribe to best help the patient (or client).

2) You would certainly fit in with a lot of premed students based upon this

3) Anecdotal evidence. However, if the idea of learning about the rest of the human body is not appealing to you, I do not think it would be a good fit. Based upon your previous thread, you have a good GPA, why not go to one of the better PsyD programs?

 

[PHD12]

2. Well, I hope this doesn't come across as arrogant but I'm a fairly ambitious person, and I feel as though I'd sell myself short by going for an NP in psychiatry. I have very little social life, so I would not be sacrificing much to pursue the PhD. It'd also be kind of embarrassing to go by the title of nurse considering how I'm a man- if everyone I knew wouldn't know (family, friends, etc.) I might consider this path, but it just seems a bit demeaning. Besides, wouldn't the research I conduct during my PhD improve my ability to develop insights into my patients and provide them with therapy?

If you care a lot about prestige, you will be disappointed as a therapist/psychologist. Most people do not know the difference between a clinical psychologist, social worker, coach etc. Your family and friends will be perplexed by why you went to school for so long "just to nod your head and listen to other people complaining."

 

[ForHumors]

If you care a lot about prestige, you will be disappointed as a therapist/psychologist. Most people do not know the difference between a clinical psychologist, social worker, coach etc. Your family and friends will be perplexed by why you went to school for so long "just to nod your head and listen to other people complaining."

+1. Do it because you love it, not for the prestige.

 

[AnnoyedByFreud]

If you care a lot about prestige, you will be disappointed as a therapist/psychologist. Most people do not know the difference between a clinical psychologist, social worker, coach etc. Your family and friends will be perplexed by why you went to school for so long "just to nod your head and listen to other people complaining."

This is so true. Granted I am a NP student, and to be honest when I first decided to switch from pursuing clinical psychology to psych NP, the idea of being a "nurse" and not pursuing a clinical psychology doctorate was a bitter pill to swallow. This is especially true because I spent 2-3 years (mostly undergrad, but one year post bacc) getting significant clinical psych research and assessment experience to make sure I would be highly competitive. Once I considered my real motivations and goals in life (and after shadowing lots of different providers) I realized how petty my concerns were and how the NP role was the obvious fit. The money doesn't hurt either. In psych, that ego stuff really doesn't matter - people will look at you funny/think you're weird for going into psych no matter what path you choose (haha) and most patients don't care either, you're their provider and that's what matters to them (this is especially true in outpatient). Also my discomfort was mitigated by attending a highly reputable school.

OP - good luck with whatever choice you make. I would highly recommend shadowing the providers in various fields and go from there. Do keep in mind that if you pursue a career where you have a prescription pad (MD/DO or NP/PA) - you will be hired to do that primarily. However, if you choose to have your own practice then you can do what you want. Also, I dunno about nursing being demeaning or whatever for men. I know lots of male NPs who work in the academic medical center my school is affiliated with and they do not seem "demeaned" or whatever you're referring to. I think when people see things on tv/read things on SDN it can really skew their view of different healthcare roles - I highly suggest shadowing around to see the reality of day-to-day practice for psychologists, psychiatrists, etc.

 

[image187]

1. I wouldn't really mind prescribing medications as a psychiatrist, even though I know how ineffective they are. I just wouldn't want to be a psychiatrist that meets with his patients for only fifteen minutes, gets a brief background of the patient's history, and hands out medication as if it's candy.

2. Well, I hope this doesn't come across as arrogant but I'm a fairly ambitious person, and I feel as though I'd sell myself short by going for an NP in psychiatry. I have very little social life, so I would not be sacrificing much to pursue the PhD. It'd also be kind of embarrassing to go by the title of nurse considering how I'm a man- if everyone I knew wouldn't know (family, friends, etc.) I might consider this path, but it just seems a bit demeaning. Besides, wouldn't the research I conduct during my PhD improve my ability to develop insights into my patients and provide them with therapy?

3. I don't know much about the residency in psychiatry itself, but I believe I'd enjoy learning about various mental disorders and their medical treatments. I do not think I would enjoy the first four years of medical school, where I will be constantly pressured to learn every aspect of the human body and medicine in general, and go through sleepless nights in clinical rotations during my third year. See the posts by NYCMS2 in this thread to hear grave warnings against attending medical school: http://forums.studentdoctor.net/showthread.php?t=1018618

4. How so?

I am only a 4th year medical student, not a psychiatrist (yet), so take my opinion with a grain of salt or two, but I believe I can speak of the medical training part. I can tell you this: You (personally) will hate it. Someone who has no interest in the "human body" or learning about medicine is not very suited for medical school. You need to memorize a million biochemical pathways, dig through a dead persons body with your hands, remember a half million equations, learn how to look at histological sections, read x rays and cat scans, wake up at 4:00 in the morning on your surgery rotation, and perform more rectal exams than you'd probably want to. And you have to not mind having to endure this for 4 years.

I have loved science and math since I was a kid and I decided to become a doctor before I eventually became fascinated with behavioral and mental health and studied psychology and did related research in college. Medical school would be a horrible choice for anyone who was only considering money or the ability to prescribe medications to people. A psychiatrist is a physician first and a psychiatrist second, so get used to interpreting QTc's, checking TSH and B12 levels, and following up on everyone's syphilis serology if you choose this route.


Also, If you remember, deinstitutionalization largely coincided with the advent of 1st-generation antipsychotics. This was the reason people's mentally I'll family members were suddenly able to come home with them and no longer had to live their lives locked up on the "back wards" of insane asylums. If you think the stigma of mental health is strong today, I suggest taking a time machine to the 1940's... the word "lunatic" can still be found in some federal laws today in 2013. Anyhow, the ethical dilemma lies not with whether or not these medications can be helpful, but with how they are used.

 

[priorities2]

I'm going for psychiatric NP and I was never really interested in chemistry or anatomy as a kid. I don't think I could take medical school. In my area, the starting salary for psych NP ranges from 75-95k and goes up to about 120k. It's also possibly to open your own practice.

I'll be a junior in college next year and just finished my nursing prereqs this past semester. I start nursing clinicals and coursework in the fall. It's only 2 years (4 semesters) of clinicals and nursing coursework and then I'll have a BSN. Nursing coursework actually looks really interesting to me. It's not like the pure pre-med track of chemistry and biology. I'm taking a class on the economics and policies of healthcare, a pharmacology class, an assessment class...

Then the PMHNP coursework really varies by school. Case Western for example has a program that focuses on family therapy. Other programs, including UPenn and some west coast schools, have really therapy-focused curricula. Then there are programs that are fully online and programs that are just like Family NP programs but with three psych courses tacked on.

 

[priorities2]

I'm going for psychiatric NP and I was never really interested in chemistry or anatomy as a kid. I don't think I could take medical school (plus I want to be a very present, not old mother). In my area, the starting salary for psych NP ranges from 75-95k and goes up to about 120k. It's also possibly to open your own practice.

I'll be a junior in college next year and just finished my nursing prereqs this past semester. I start nursing clinicals and coursework in the fall. It's only 2 years (4 semesters) of clinicals and nursing coursework and then I'll have a BSN. Nursing coursework actually looks really interesting to me. It's not like the pure pre-med track of chemistry and biology. I'm taking a class on the economics and policies of healthcare, a pharmacology class, an assessment class...

Then the PMHNP coursework really varies by school. Case Western for example has a program that focuses on family therapy. Other programs, including UPenn and some west coast schools, have really therapy-focused curricula. Then there are programs that are fully online and programs that are just like Family NP programs but with three psych courses tacked on.

 

[psychRA]

1. I wouldn't really mind prescribing medications as a psychiatrist, even though I know how ineffective they are. I just wouldn't want to be a psychiatrist that meets with his patients for only fifteen minutes, gets a brief background of the patient's history, and hands out medication as if it's candy.

I've only worked in a few clinical settings so far (starting postdoc this fall), but in every place that I've worked (community mental health center, university clinic, VA), psychiatrists have primarily done initial assessments and periodic med check visits. Not saying that that's true everywhere, of course, but my sense is that if you want to work in any kind of setting where a 3rd party is reimbursing you for your services, it is going to be very difficult to practice therapy as a psychiatrist. Blue Cross does not want to pay an MD $300 an hour for a service if they can get away with paying $125 to a PhD or $100 to an LCSW (numbers are made up, but you get my point). If you are in private practice and your patients are all paying out of pocket, then sure - if you have training in psychotherapy and people are willing to pay for it, you can provide it. However, I am guessing that people who are willing to shell out hundreds of dollars to see a private practice psychiatrist for therapy are probably also going to want you to write prescriptions for them, assuming they're warranted. I could be wrong, but if a patient really only wants therapy and not meds, it would make a lot more sense to see a psychologist, since we're a lot cheaper and have years of therapy training.

It does seem like a really bad idea to plan a career around prescribing medications that you don't seem to support. Even if you're willing to write prescriptions, if you're convinced that they're ineffective, how are you going to keep yourself engaged and informed about the process of choosing which meds to prescribe and when? I have a TON of respect for my psychiatrist coworkers - it is a tough job that requires you to integrate a lot of medical and clinical information, and I don't think that someone who sees him/herself as just a "pill pusher" would be able to hack it over the long term. As someone who has treated patients with psychotic disorders and severe mood disorders, I can assure you that meds most definitely are effective for many people, and especially for certain conditions.

 

[priorities2]

A lot of psychiatrists/psych NPs do go into private practice though and can do as much therapy as they want, I suppose they would just lower their salaries doing this though?

 

[Qwerk]

I've only worked in a few clinical settings so far (starting postdoc this fall), but in every place that I've worked (community mental health center, university clinic, VA), psychiatrists have primarily done initial assessments and periodic med check visits. Not saying that that's true everywhere, of course, but my sense is that if you want to work in any kind of setting where a 3rd party is reimbursing you for your services, it is going to be very difficult to practice therapy as a psychiatrist. Blue Cross does not want to pay an MD $300 an hour for a service if they can get away with paying $125 to a PhD or $100 to an LCSW (numbers are made up, but you get my point). If you are in private practice and your patients are all paying out of pocket, then sure - if you have training in psychotherapy and people are willing to pay for it, you can provide it. However, I am guessing that people who are willing to shell out hundreds of dollars to see a private practice psychiatrist for therapy are probably also going to want you to write prescriptions for them, assuming they're warranted. I could be wrong, but if a patient really only wants therapy and not meds, it would make a lot more sense to see a psychologist, since we're a lot cheaper and have years of therapy training.

It does seem like a really bad idea to plan a career around prescribing medications that you don't seem to support. Even if you're willing to write prescriptions, if you're convinced that they're ineffective, how are you going to keep yourself engaged and informed about the process of choosing which meds to prescribe and when? I have a TON of respect for my psychiatrist coworkers - it is a tough job that requires you to integrate a lot of medical and clinical information, and I don't think that someone who sees him/herself as just a "pill pusher" would be able to hack it over the long term. As someone who has treated patients with psychotic disorders and severe mood disorders, I can assure you that meds most definitely are effective for many people, and especially for certain conditions.

This.

I've had similar experiences in the places I've worked. I have met psychiatrists who do perform psychotherapy, but they're not common, and you'll never find one working anywhere but a private practice. The psychiatrists in the program at which I last interned were (as far as my limited experience could tell) competent and compassionate, and certainly would have loved to be able to see their patients for more than 15-minute slots. Unfortunately, the program was understaffed and everyone needed their med refills, so they were squeezing hundreds of clients in per week. This is typical, not the exception.

Echoing the M.S.W. thing, assuming you have access to a good clinical school. Post-grad institute training can be a good thing, too. Most of the experienced therapists I know have it. (Then again, I'm in NYC, which is very institute-heavy.)

 

[PHD12]

All the psychiatrists that i know in PP out here spend a portion of their time doing psychotherapy (at least 30%, some 50%), and have 3-6 month wait lists.

When you are a psychiatrist, you can literally work part-time in PP and make enough money so many of them just do med management for part of the time and then fill the rest of the time with psychotherapy patients. I have yet to meet a psychologist with a wait list---maybe someone famous like Beck? One of my psychiatrist buddies out here decided to quit his full-time job and do this per diem job so that he can work only 2 days per week and still makes a high salary. The demand and supply for psychiatrists vs. psychologists can't be more different. Meanwhile, the psychologists that i know have full-time jobs and need to supplement income with PP on the side so they are working at least 2 jobs and come home late at night.

It's always preferable to have more flexibility and higher salary from the onset in my opinion. That will give you the most freedom to do more of what you want. As a psychologist you will likely never be able to prescribe (aside from 2 states that most people don't want to live in) and you will likely not be able to get away with not taking insurance (another huge hassle). What can a psychiatrist NOT DO that a psychologist can do? Maybe just neuropsych testing?

 

[Doctor Eliza]

All the psychiatrists that i know in PP out here spend a portion of their time doing psychotherapy (at least 30%, some 50%), and have 3-6 month wait lists.

When you are a psychiatrist, you can literally work part-time in PP and make enough money so many of them just do med management for part of the time and then fill the rest of the time with psychotherapy patients. I have yet to meet a psychologist with a wait list---maybe someone famous like Beck? One of my psychiatrist buddies out here decided to quit his full-time job and do this per diem job so that he can work only 2 days per week and still makes a high salary. The demand and supply for psychiatrists vs. psychologists can't be more different.

In addition to the luxury of having a wait list, many psychiatrists around here run cash only practices (i.e., don't take insurance) so they get what they charge (a LOT). Psychologists here rarely can get away with that unless they are near retirement, have a good reputation, and are okay to work only part time.

That said, the OP shouldn't go to med school due to his/her negative attitude toward medications. However, folks who are on the fence because they are intrigued by the body and would enjoy being a physician, should go for it.

Dr. E

 

[priorities2]

Well, just to play devil's advocate, the OP is still in college from the sound of it... his attitude about medication could definitely change over time, and it's possible to be a psychiatrist (or psych NP) who at least tries to convince people about the efficacy of therapy for certain disorders before writing a prescription. Just because you CAN write prescriptions and are the person actually doing that task doesn't mean your ideology needs to be different from the MSW or psychologist who referred a client to you, right?

Idk, I'm going to be a psych NP and I'm interested in consulting for primary care physicians to give more insight into a care plan for people who come in with symptoms of mental illness. I know someone who has been on depression meds for 16 years and barely ever gone to therapy, because her family provider prescribed her prozac or w/e a really long time ago. I imagine these incidents are not considered ideal by the psychological establishment? I think having more psych NPs could help solve the problem..

 

[karamello24]

I see your conflict. How about looking into an MSW program at a good state school to reduce cost? LCSW's practice psychotherapy and are hired more often as therapists compared to psychologists. Cons: generally low salary and most therapists have pretty bad working conditions because of the way health care is run these days, such as high case loads and inability to see patients regularly (this is the case for both PHD and PsyD graduates too if they have a 100% clinical role in many settings). However, if you are okay with living simply in a low cost of living location, this can work. Also, the VA tends to have good working conditions for therapists overall compared to most other settings.

Another option is NP in psychiatry. Only 3 years of training so significantly better than psychiatry and psychology. From talking to NP's, the curriculum is more interesting/integrative than medical school, which focuses on memorizing more. Pros: higher salary than both MA therapists and PsyD/PhD therapists. Cons: you will still have to prescribe medication.

I don't think the PhD is a good fit if you want "only" want to be a psychotherapist. It's going to be 7-8 years of training and you will have to do research, often master's thesis, and dissertation. This is going to be painful if you don't enjoy research. PsyD also requires a dissertation, but is too costly unless you get into the 2 or so PsyD programs that have good outcomes are are affordable. Plus, as I mentioned, the way our health care system is run it is not a pleasant place to be in a 100% psychotherapist role, and most cannot practice according to high standards at hospitals. Plus, therapists on the doctoral level tend to have some of the lower incomes compared to psychologists who also do testing, research etc.

In terms of psychiatry, i'm not sure why you are calling it hell. How much do you know about the education and curriculum?

In treatment is also not a good characterization of what therapy is really like.

Good luck!

This response seems to be dismissive of Psy D. programs in general, as if they are not viable or not quality degrees at all!

 

[Therapist4Chnge]

This response seems to be dismissive of Psy D. programs in general, as if they are not viable or not quality degrees at all!

That is par for the course for PHD12. 😉

 

[PHD12]

That is par for the course for PHD12. 😉

I do actually recommend university-based PsyD programs that are funded and have good outcomes (75%-80% or more APA match rates). I have also said in several of my posts that there are many PsyD graduates from good programs that are in high level positions in our field all over the country.