MD or PHD or something else?

[oldladypremed]

Hi everyone,

Sorry to be such a pest on this board but I'm really so glad to find such a nice group to answer my questions.

I'm trying to make some major decisions about the future. I have almost all my premed requirements finished but I'm not sure that medical school is the right way to go. My ideal future job would be mostly psychotherapy with med management as an adjunct for those clients who need it. I love the "talk" part of this field and from the counseling and alternate dispute resolution I've done with my law clients, I think I'm pretty good at it.

In the places you have worked and the practices you have seen, how involved with psychotherapy have the psychiatrists been? Is that left mostly to Phd's and others? Am I kiddind myself thinking I can do both?

A Clinical PHD would also take me many years to complete although I wont have the grueling hours away from my family. I also assume that I will end with less debt.

I know this is a very personal decision but I would love any opinions you all can provide.


Oldlady

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[alina_s]

Have you actually researched the debt side of this issue? Not that it should be the primary determinant but...my impression from my friends who have gone to grad school in research fields versus clinical psych is that the aid isn't as good for clinical psych. Many research-oriented programs give a full ride plus living stipend and I am not sure that that's true for clinical psych. Clinical psychology programs are also quite competitve, on a similar level to medical school. I worked with a lot of psych grad students and they weren't optimistic about the job market either- I heard stories of grads being happy to get positions that paid as badly as a bachelor's level research assistant- so lower debt might still hurt more. If you're really worried about the debt side of medical school, you might want to look into the NHSC scholarship and loan repayment programs.
Medical school is sometimes brutal but when I was deciding between medical and graduate school, several psycholgists told me that they would have gone to medical school if they had had the choice because psychiatrists have a bit more autonomy. I had the impression that as a psychologist, it is much harder to go into solo practice and perhaps harder to find a practice that you "fit" into. There are some successfull solo practice psychologists, though, who have get by without accepting insurance at all- complete autonomy- but that sounds risky and rather limits the patient population. Of medical residency programs, though, psychiatry is one of the gentlest. If you decide on med school, make sure to ask about the call schedules during third year.
As far as psychiatrists practicing psychotherapy, it seems to vary quite a bit. The psychiatrists that I worked with in research got to spend a lot more time with patients because the research grant, not insurance, was paying. Academic positions pay less too, so they pay a price for that privilege. Spending some time in the psychiatry department at school now, it seems that non-research psychiatrists still get to take more time with their patients than many others. The department has many psychologists, too, though, who can have more frequent and longer sessions with the patients. Hope all this helps a bit with your decision.

 

[cici]

Originally posted by alina_s
Many research-oriented programs give a full ride plus living stipend and I am not sure that that's true for clinical psych.

What you said is not true. Clinical psychology PhD's (not PsyD's) get fellowships and grants, and actually that's 1 of the admission criteria (that a program either has to provide you with financial support, or you'll have to be a recipient of some national fellowships)......since clinical psyc students are required to do research besides getting clinical training (and research training is supposed to be their priority). Money-wise, they're the same as other research-based psychology graduate students.

I worked with a lot of psych grad students and they weren't optimistic about the job market either- I heard stories of grads being happy to get positions that paid as badly as a bachelor's level research assistant- so lower debt might still hurt more.

I'm wondering whether you're talking about PhD grads? If yes, that's again not true. In terms of job prospect, clinical psychologists are in great demand -- so many faculty members are retiring now, and hospitals are also hiring.

I had the impression that as a psychologist, it is much harder to go into solo practice and perhaps harder to find a practice that you "fit" into. There are some successfull solo practice psychologists, though, who have get by without accepting insurance at all- complete autonomy- but that sounds risky and rather limits the patient population.

I'm not sure what you mean by that. MANY clinical psychologists have private practices. They either work as a private practitioner, affliate with a hospital, or both. They can also go into academia AND practise.

 

[PublicHealth]

Clinical psychologists often find themselves working as researchers first, and practitioners second. In fact, clinical psych PhDs have almost completely been replaced by MSWs and MA-level therapists who are simply cheaper. Reimbursement for services is another issue. Today, clinical psychologists and neuropsychologists are having a difficiult time getting reimbursed for their services, and when they do, it's no where near the amount that psychiatrists take in. At the same time, psychiatry as a field has been transformed into an enterprise characterized by "pill-pushing and med checks." The psychotherapeutic humanity of psychiatry is severely, IN MY OPINION, lacking.

Every psychologist -- clinical, health, and otherwise -- that I have talked to about this issue has concluded that the role of clinical psychology in the years ahead is uncertain. While the research some clinical psychologists produce is, in many ways, clarifying various issues in psychiatry, their role as practitioners is becoming diminished as pharmacotherapy expands.

Because I really enjoy research, I'm facing a similar dilemma insofar as I am torn between clinical psych PhD programs and medical school/psychiatry. Judging by the tenor of my aforementioned paragraphs, I have chosen to pursue the latter.

Feel free to e-mail me with further questions. I have thought long and hard, and discussed this issue at length with several psychologists, psychiatrists, social workers, and research psychologists, and have consistently gotten the same answer -- "go to medical school."

Cheers,

PH

 

[Sanman]

Public Health,
I'm just curious as to what you've heard of the future of psychologists as far as neuropsych and psychological testing since no one else does testing. I have heard that reimbursement is declining, but thats pretty much true for all mental health providers. Just curious because I'm considering neuropsych and working with LD/ADD.

 

[PublicHealth]

Hi, Sanman.

Neuropsychology and psychological testing are critical to neurology, neurosurgery, and psychiatry. In fact, neuropsychologic evaluation is often the ONLY way to evaluate specific cognitive deficits and rule out certain morbidities (e.g., dementias, MCIs, TBIs, etc.).

Michael Westerveld, Ph.D., who is a neuropsychologist in the Dept. of Neurosurgery at Yale, told me that the future of neuropsychology is uncertain. Neuropsychology is not recognized as a primary medical specialty, and as a result, clinical neuropsychologists are not reimbursed very well for their services. According to Dr. Westerveld, this situation is supposed to only get worse in the years ahead. Nevertheless, I know of several clinical neuropsychologists who are able to balance their time conducting clinical evaluations and doing research. Salary is typically in the $50-75K range. From what I've heard, competition for neuropsychology fellowships is pretty keen, and the PhD route typically takes about 5-6 years, depending on the program. Together with fellowship, you're looking at 7-9 years of training at the very least.

I highly recommend Yale's Child Study Center for postdoc training in ADD/LD. Feel free to PM me if you have additional questions -- I love talking about this stuff!

PH

 

[alina_s]

Cici- I worked in the psychiatry department but many of my co-workers were clinical psych PhD students (not PsyD, whatever difference it would make) from an APA-certified program. One student was working full-time outside of his program so that he wouldn't need to take out loans for living expenses and most students were taking out loans for at least part of their living expenses. I know nothing about the program's ranking but I don't think it was badly off- it seemed pretty well-funded. And the more advanced students weren't optimistic about the job market- there may be a huge need for mental health workers but there isn't a huge mental health budget anywhere. There may be academic openings but the competition for those is huge; I did my undergraduate at a top-ranked psychology graduate program and the grad students there had the walls plastered with rejection letters too. As PublicHealth said, psychiatry may be in trouble in our health care system, but psychology looks worse. I had four work supervisors who were clinical psychologists and three of them said that they wouldn't take that path again if they could start over.

 

[PublicHealth]

When you think about the business of medicine, it is clear why psychology doesn't really fit. While behavioral risk factors underlie practically every cause of death in the U.S. (McGinnis & Foege, 1993), American medicine is simply too focused on "quick fixes" and expensive procedures.

In psychiatry, brief treatment is the equivalent of "quick fixes," and pharmacotherapy and ECT are the equivalent of "expensive procedures." These equivalents will keep psychiatrists in business in the years ahead.

 

[Sanman]

Personally, I think that the future of psychology as far as PhD's are concerned is in testing. It seems that traditional psychotherapy for the most part will be the domain of those with masters degrees. Though I think that they will do therapy in fields that connect with medical fields, such as cognitive behavioral therapy in sleep psychology, possibly chronic pain, etc. I also think that psychology in educational settings will bloom. I also think that neuropsych will become more of a research field tied in with neurology. Just my guess as to where the job markets will end up in psychology. Any opinions?