MD or PhD?

[papillonparade]

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Hi everyone,

I currently work as a research assistant and have been slowly realizing how difficult it is to get an internship or a research job with a PhD. I'm starting to wonder if an MD (psychiatry) wouldn't be a better option. I actually think my chances of getting into med school would be much better, as I have experience in several specialties and virtually no pure psychology experience.

I am very torn between research and clinical work and have not been able to decide after several years of trying to pick. The reason I would like to get either an MD or a PhD is it would give me the flexibility to go into either research or clinical work (or, preferably, do clinical work for research applications). It could just be where I work or my field, but it seems that MD's generally have an easier time getting funding for grants than the PhD's.

I'm just wondering if an MD can't basically do everything a clinical psychologist can do and then some, plus they get paid more/better job security. Any thoughts? Pros and cons of each?

 

[bcliff]

If you have your premed coursework completed and have taken the MCAT, or would be willing to, then I think applying to med school is definitely an option. Doing research with an MD is completely feasible, and reimbursement for clinical work done by a psychiatrist is often higher than the reimbursement rate for a psychologist. The education you will receive in med school vs. clinical psych phd is going to be quite different though, and instead getting a firm background in research methods; stats; and general psych theory, you'll obviously get a stronger background in A&P and the natural sciences. Post on some of the psychiatry forums to hear what some of the MD folk have to offer.

 

[Therapist4Chnge]

I'm just wondering if an MD can't basically do everything a clinical psychologist can do and then some, plus they get paid more/better job security. Any thoughts? Pros and cons of each?

If you do a search on the forum you'll find dozens of threads that address your questions.

 

[psychRA]

I'm just wondering if an MD can't basically do everything a clinical psychologist can do and then some, plus they get paid more/better job security. Any thoughts? Pros and cons of each?

I agree wholeheartedly with the better pay/better job security. I disagree with the "everything a clinical psychologist can do and then some."

For some context, I've finished the uni-based part of my PhD training and am now on internship at a competitive site. I've been in group supervision and trainings with psychiatry residents, and I've talked with staff members who train both psychology and psychiatry residents. The consensus (in my experience) is that psychiatrists receive very little training in any kind of therapy, at least prior to residency. In group supervision, they are usually less familiar/comfortable with the theory and practice of therapy than even the psychology practicum students. I've found that psychiatry residents need to be brought up to speed on even the basic stuff (establishing rapport in therapy, providing rationale for treatment, using evidence based practices) that psychology students are typically covering in their first and second year of coursework. They also require a lot more instruction and supervision when it comes to doing therapy.

And I'm not knocking psychiatrists here - it makes sense that they're not necessarily equipped to do therapy, because (unlike psychology trainees) they haven't spent the last 5-6 years intensively learning and practicing therapy. Yes, I get bored in group supervision with psychiatry residents, because I find that the supervisor ends up covering a lot of material that would be remedial for me. They're not well-trained when it comes to therapy. And I am not even remotely trained in medicine, because unlike me, the psychiatry residents have spent the last few years learning about the human body, medical practice, and psychopharmacology, which I am completely incompetent to practice. It makes sense that psychiatrists don't get a lot of training in therapy, because that's not where the money is, and realistically, most (not all) psychiatrists are going to end up in settings that require them to primarily prescribe medication.

I'm rambling now, but in my experience, the take-home message is that if you want to practice medicine/prescribe medication, get an MD, and if you want to do therapy, get a PhD or an MA. I think that you can have a research career in either discipline.

 

[PHD12]

Psychologists get more extensive training in psychotherapy and research (you will complete a dissertation and master's thesis).

However, in the real world, the MD's are treated as kings in the sense that they are in demand, have an easier time taking on upper-level managerial roles in hospitals, and command a higher salary (sometimes 3x more depending on the position). For example, at the VA hospitals where I've trained the psychiatrists were always the chiefs of mental health at the highest level. When we had any openings for psychiatrists, it was very tough to find ANYONE to fill in the position even though the salary was close to 200K (one of the psychiatrists that left took on a job for 400K). Most of the psychiatrists were from foreign medical schools because there is such a shortage of psychiatrists. I have another psychiatrist friend in a high cost of living location and her base salary is 250K, but she nets 400K due to overtime (she is paid $160 per hour for overtime at a hospital). On the other hand, whenever there was 1 opening at my VA for a psychologist, the head psychologist informed me that there were literally more than a hundred applicants. It's the opposite for psychiatrists.

Also, I work extensively with psychiatrists and from my experience they DO NOT put in more hours than psychologists. They have a strong union so they negotiate lot's of perks and can get out of certain responsibilities (many are thrown onto the case managers and psychologists). This will vary depending on the hospital though. It's just so much easier to negotiate perks if your position is tough to fill.

Oh and by the way, regardless of their training, all the psychiatrists I know in private practice are doing a split between medication management and psychotherapy (50/50). In my location, they charge more for psychotherapy than psychologists and they all have 3-6 month wait lists. it's much easier for them to get patients because they provide both the medication management and the therapy. I don't know about how extensive their psychotherapy training is, just pointing out that in the real world they do provide some psychotherapy and the MD tends to be very respected among wealthy clients. The MD is just so much more predictable in terms of job security and salary. The salaries for psychologists are so highly variable. On the lower end of the scale, they are nearly impossible to survive on.

 

[Doctor Eliza]

Lots of good points have been made in this thread and on this board. All I can say is that as a licensed psychologist if I had a time machine, I wouldn't think twice about going back in time to become a psychiatrist. The difference in opportunities is astounding. There is such a need for good psychiatrists out there.

Dr. E

 

[edieb]

There are a lot of people on SDN that will try to tell you that psychiatry is in the same boat at psychology. Do not believe a word they say because they seem to have an alternate reality of some kind. Do your own research by looking on the internet for jobs for both professions. Not only will you see 20x more jobs for psychiatrists (despite there being fewer of them), the jobs pay 4x more. One smart thing to do is to put out shell resumes at mental health recruiting sites and gauge the number of calls you receive for the PhD and the MD

As far as training, PhDs and MDs are definitely trained to different things; however, it is important to remember that most of the skills we are trained in there is little demand for (despite them being very important).

I attended a very, very research-based Clinical PhD program but took a very keen interest in conducting very evidence-based CBT. I read hours and hours on CBT after completing my research duties in my program. I continued this for 3 years, even doing this in addition to working on my dissertation after my internship. After my internship I realized what my major professor said, in essence that "employers don't care about how good you are in practicing CBT or testing" was true. Unfortunately, the healthcare system is largely based on quantity, not quality. Thus, chances are the in-depth skills you learn during grad school will be supplanted by the need to see 7 patients a day.... With psychiatry, you can make enough in the mornings that you have time to do leisurely therapy in the afternoon (or pursue whatever academic interests you have)


Another observation: Psychological testing is largely dead outside of some V.A.s and medical schools. Insurance will not really even reimburse you for it very often.. From my experience at the DoD, it wasn't valued either.

I was working at the V.A. and the DoD before I became a prescriber. I remember one duty at the DoD was to do assessments on persons who wanted to attend sniper school. I asked if I could do psychological testing with these people and he said I could not because the DoD had cut moneys for machine scoring.

 

[bcliff]

How would a prescribing psychologist relate to a psychiatrist salary/demand wise?

 

[PHD12]

How would a prescribing psychologist relate to a psychiatrist salary/demand wise?

I think there are only 2 states that allow psychologists to prescribe (New Mexico, Louisiana). We have barely made any progress on this end in 30 years so I don't think it's going to be a realistic option for psychologists.

 

[bcliff]

If a psychologist is allowed to prescribe in NM or LA, and they worked for the VA in another state, would that allow them to prescribe in that state?

 

[PHD12]

If a psychologist is allowed to prescribe in NM or LA, and they worked for the VA in another state, would that allow them to prescribe in that state?

I don't know how credible wikipedia is, but there is a ton of information on here with links to articles/websites: http://en.wikipedia.org/wiki/Prescriptive_authority_for_psychologists_movement

As far as I know, you can't prescribe at all as a VA psychologist.

 

[edieb]

I am a prescribing psychologistt and, before this, I worked in the V.A. I conpleted my coursework at New Mexico State University in the Education and Counseling Psychology Department.

Prescribing psychologists cannot prescribe in the V.A. but can in the Department of Defense and all branches of the military + New Mexico and Louisiana. I can prescribe in another state if I do so via telemedicine. To answer the billing questino, I do not bill under psychiatrist codes but bill under a special subset of codes for medical psychologists and make signficantly more than a psychologist or nurse practititioner for a 35-40 hour week

 

[HomeworkHelper]

Here are a couple thoughts that might be helpful for OP. In undergrad, I was deciding between an MD and PhD. It was a draw for a few years. What helped me make my mind up, ultimately, was some advice that I got from a professor. He told me that both professions would entail a career-long learning process to stay current in the field. He asked me to consider whether there was a big difference in how much I would enjoy continuing my education in either area over the years. I greatly enjoyed learning about topics consistent with clinical psychology as opposed to psychiatry (and I realized I abhorred the idea of studying the topics in medical school once I found out what all they were) so I chose clinical. It might be helpful to think about what kinds of topics you enjoy learning about, and maybe check out journals associated with each profession.

 

[pretzels]

Here are a couple thoughts that might be helpful for OP. In undergrad, I was deciding between an MD and PhD. It was a draw for a few years. What helped me make my mind up, ultimately, was some advice that I got from a professor. He told me that both professions would entail a career-long learning process to stay current in the field. He asked me to consider whether there was a big difference in how much I would enjoy continuing my education in either area over the years. I greatly enjoyed learning about topics consistent with clinical psychology as opposed to psychiatry (and I realized I abhorred the idea of studying the topics in medical school once I found out what all they were) so I chose clinical. It might be helpful to think about what kinds of topics you enjoy learning about, and maybe check out journals associated with each profession.

+1

This is / was the main reason I also steered away from psychiatry. I just had no interest in being a general physician and knew I'd be terrible at it.

 

[nitemagi]

I'm just wondering if an MD can't basically do everything a clinical psychologist can do and then some, plus they get paid more/better job security. Any thoughts? Pros and cons of each?

The job security is there as an MD psychiatrist. There are also MD/PhD programs that will get you outstanding research experience during med school and pay for your education (though usually in basic science).

High end academic residencies often have research tracks with the intention of getting you a T32 by the time you finish, moving towards an R01.

They're definitely not the same. Going the MD route offers more flexibility, but if you want the therapy training and/or research training it'll require more self-directed learning on your part (though I believe therapy is really best learned longitudinally anyway).

The training itself is different, even in the clinical populations. Residency is hard work, and usually involves more hours with sicker patients compared to psychologists (at least 2 years of residency can focus on hospitalized patients in various settings, including subspecialty units). Longer hours, many patient evaluations in emergency and shorter duration. Psychologists often have more longitudinal experience with fewer patients, getting to know their patients better.

I'm happy with my choice.

 

[Nihl]

Here are a couple thoughts that might be helpful for OP. In undergrad, I was deciding between an MD and PhD. It was a draw for a few years. What helped me make my mind up, ultimately, was some advice that I got from a professor. He told me that both professions would entail a career-long learning process to stay current in the field. He asked me to consider whether there was a big difference in how much I would enjoy continuing my education in either area over the years. I greatly enjoyed learning about topics consistent with clinical psychology as opposed to psychiatry (and I realized I abhorred the idea of studying the topics in medical school once I found out what all they were) so I chose clinical. It might be helpful to think about what kinds of topics you enjoy learning about, and maybe check out journals associated with each profession.

That was exactly my experience as well. I had to sit down and think about what I wanted to experience during my life. Going the med school route really wasn't what I wanted. I was not interested in learning all of that material, and then not having the patient interactions I was hoping for. I completed my pre-med and psych (behavioral neuro) BA, and thought about it for a few years. I worked in a huge lab at an ivy med school and decided that I really wanted to do clin psych. Right now I am on an internship during my masters, and I work with psychologists and psychiatrists. The money is nice, but psychiatrists don't have the relationships with their patients and/or work with the same types of problems I am interested in. Sometimes I regret the decision, sometimes it's annoying at how psychiatrists treat you and receive all the prestige and big paychecks.... but I know that I am much better at what I do.

 

[Sanman]

It really depends on what you want to do and how well you plan your career. The difference between psychology and psychiatry is that, more often, academic and VA positions pay among the highest salaries in psychology and the lowest in psychiatry. There are many more private practice options if you want to do psychiatry. Med School has more debt and more of a time involvement, but the pay is steadier after school and the process is more structured. Research can be done through either track, but may differ slightly in focus. Psychiatry is more squarely focused on mental illness while psychology is a bit more widespread and integrative (my focus was on health psych and traditional mental illness). The truth is that in either job, you may not end up working with the populations you planned on working with unless you find the right job. I know many here regret not doing medicine, but I do not. I would have been a more medical physician (neurologist most likely) or done something like speech language pathology or audiology. I much prefer health psych cases and really do not enjoy the traditional mental illness cases I manage. Whatever route you choose, manage your finances well. Expensive private schools are not your friend when pursuing either path.

 

[Psychonergic]

Just to throw in my 2-cents...I've seen many threads within this forum concerning the differences between Ph.D.'s and M.D.'s, but infrequent mentioning of D.O.'s. I would imagine that many prospective applicants to graduate school for clinical psychology, and medical school, would find a warm reception at osteopathic medical school. After all, the whole osteopathic platform is based on a holistic approach to the person and the treatment. In fact, with a background in psychology (and philosophy) and hospital based research experiences, I was told by a dean of an osteopathic school that I would be a strong candidate (assuming I did well in pre-req courses and at least average on the MCAT).

I'm pro-psychiatry, providing that practitioner is passionate about their work and interested in the field. I believe the D.O. schools have this particular philosophy in mind, and may produce especially patient-centered psychiatrists (Obviously, the allopathic school can, and do, as well). There is so much promise for the future of psychiatry with the explosion of neuroscientific and psychological research. The goals of both the ologist's and iatrist's are similiar - I suppose it's deciding how you want to contribute to your community's well-being.

 

[pretzels]

It really depends on what you want to do and how well you plan your career. The difference between psychology and psychiatry is that, more often, academic and VA positions pay among the highest salaries in psychology and the lowest in psychiatry. There are many more private practice options if you want to do psychiatry. Med School has more debt and more of a time involvement, but the pay is steadier after school and the process is more structured. Research can be done through either track, but may differ slightly in focus. Psychiatry is more squarely focused on mental illness while psychology is a bit more widespread and integrative (my focus was on health psych and traditional mental illness). The truth is that in either job, you may not end up working with the populations you planned on working with unless you find the right job. I know many here regret not doing medicine, but I do not. I would have been a more medical physician (neurologist most likely) or done something like speech language pathology or audiology. I much prefer health psych cases and really do not enjoy the traditional mental illness cases I manage. Whatever route you choose, manage your finances well. Expensive private schools are not your friend when pursuing either path.

Is that really the case? I always understood it to be mostly the opposite; that because a psychiatrist was a physician first, he had more background in general health, while a psychologist, whether in research or clinical practice, was always focused more on the brain state, or the mental aspect of the situation than anything else.

 

[Sanman]

Is that really the case? I always understood it to be mostly the opposite; that because a psychiatrist was a physician first, he had more background in general health, while a psychologist, whether in research or clinical practice, was always focused more on the brain state, or the mental aspect of the situation than anything else.

This is absolutely true, IMO. Psychiatry and medicine, in general, is much more specialized than psychology. That has positive and negative aspects. Things like integrative health are much more likely to be studied by psychologists and primary care physicians, effects on behavior and cardiovascular disease by psychologists and cardiologists, effects of behavior on sleep by psychologists and sleep medicine physicians (usually pulmonologists, neurologists, or psychiatrists), etc. Psychology has done more to collaborate on all kinds of research. Psychiatry, in the real world, is much more focused on mental illness (I chose those words carefully) rather than mental health. That said, in the non-academic world it is much easier to get a job that pays well with an MD. Whether M.D. or D.O., the reality is that you are going to most likely get a job managing mental illness, if you are not in an academic setting. Psychologist jobs pay less and can be harder to find, but allow for a wider variety of jobs. In my job, I get to really work with the medical team and manage a pt while psychiatry just precribes whatever meds based on my suggestion and that of the primary care doc. Sometimes, the primary care doc will work with me if there is just a routine medication need (xanax for an anxious pt I am working with the comply with treatment) wiithout the psychiatrist being involved. Having fairly extensive neuropsych training, I usually know the most about dementia as well with the exception of a neurologist or the rare psychiatrist that actually has geriatric training.