MD to do a PhD instead of psych residency?

[subalpinesun]

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Would really appreciate any thoughts on this. I'm graduating from med school in a year (hopefully). Psych is what interests me the most. But this is my predicament. I really dislike the people and culture of medicine, which has made me more unhappy/neurotic than I've probably ever been (to the point that I'm concerned that I wouldn't make an effective shrink). Plus I'm not interested in the pharmaceutical treatment of mental illness and don't really buy the biopsych model at all. Psychotherapy, psychoanalysis, etc is what really makes me salivate. I know there are some residency programs that emphasize psychoanalysis so that is something I'm looking into. But I have no debt and there is the option of getting my MD then doing a PhD in psych and learning about what really interests me in the psych realm. Another problem - the PhD programs that attract me the most are not mainstream programs - e.g. California Institute of Integral Studies, and Pacifica Graduate Institute. I noticed that CIIS' accreditation is currently on appeal which is definitely not a good sign.. So I'm struggling with this. I don't want to practice like a psychiatrist in any way shape or form, I want to practice like a PhD. On the upside I think having an MD next to my name would definitely lend some extra credibility to someone with views regarding psych like I have.

Any advice on the pros/cons of going into one of these PhD programs vs MD residency? I'm really naive about this. Would I be able to get license to practice psychotherapy after getting my PhD or would more training be required, etc?

 

[JustNoticing]

Extra credibility and an even higher premium if you live in a market with plenty of wealthy cash pay patients. There are MDs in NYC who do cash pay psychotherapy at $300-500 per hour. I say do a residency that will allow you to focus on psychotherapy. You may find it to be very different than your medical training until this point. you can always study at one of those California institutes after/during residency or get an advanced certificate of some sort. I think there is room for a few more anti-psychiatry psychiatrists out there.

 

[Sanman]

Agreed. Going back now won't really help you in any way shape or form. Find a residency you like and when you are done, practice as you see fit. I know of a few psychiatrists that went to one of the psychoanalytic institutes for training later on (another 4-5 years). You can even start during residency if you are in NYC, Washington DC, or near one of the other psychoanalytic institutes. At the end of the day, you need a credential more than the education. The education can be learned in many ways. You can choose to forgo some of the money to pursue more therapy related skills. A certificate program of some kind would likely provide you with what you are looking for. If you feel the the need for more than that, who can always get a masters in a therapy focused program. Bottom line will be that you can still eat even doing part-time med checks and part-time therapy, but your bottom line may just be less than some of your colleagues.

 

[roubs]

Would really appreciate any thoughts on this. I'm graduating from med school in a year (hopefully). Psych is what interests me the most. But this is my predicament. I really dislike the people and culture of medicine, which has made me more unhappy/neurotic than I've probably ever been (to the point that I'm concerned that I wouldn't make an effective shrink). Plus I'm not interested in the pharmaceutical treatment of mental illness and don't really buy the biopsych model at all. Psychotherapy, psychoanalysis, etc is what really makes me salivate. I know there are some residency programs that emphasize psychoanalysis so that is something I'm looking into. But I have no debt and there is the option of getting my MD then doing a PhD in psych and learning about what really interests me in the psych realm. Another problem - the PhD programs that attract me the most are not mainstream programs - e.g. California Institute of Integral Studies, and Pacifica Graduate Institute. I noticed that CIIS' accreditation is currently on appeal which is definitely not a good sign.. So I'm struggling with this. I don't want to practice like a psychiatrist in any way shape or form, I want to practice like a PhD. On the upside I think having an MD next to my name would definitely lend some extra credibility to someone with views regarding psych like I have.

Any advice on the pros/cons of going into one of these PhD programs vs MD residency? I'm really naive about this. Would I be able to get license to practice psychotherapy after getting my PhD or would more training be required, etc?

Your medical license is the only license you need to practice psychotherapy. Many people view the MD/psychiatrist title as a premium credential so you can figure out whatever psychotherapy you want to do, get extra training and charge waay more than a Ph.D./Psy.D. ever could for the same service. The only downside is you will have to grin and bear it through psychiatry residency. But I think it would behoove you to do so--your nice psychotherapudic approach could sometimes benefit w/ an assist from some pharmacotherapy-- especially with patients who have severe symptoms.

 

[bmedclinic]

Hi!
When you say "practice like a PhD", what do you mean? Do you mean billing wise for therapy?
Or do you mean doing research?

As someone who will have a phd and loves fitting intot he nitche where PhD's and MD's work closely and collaborate, I'd love to hear more specifics on what you'd like to do long term.

I'd also love to tell you about the integrated primary care model- I bet you already know about Primary Care Medical Home (PCMH), but that's a growing area that lots of VA's support and it needs MD's who can think and communicate like PhD's and vice versa. So, know that whatever route you end up going, there certainly is a fit out there for you.

 

[subalpinesun]

Guys thanks for the thoughts - really helpful.

@bmedclinic When I say I want to practice psych like a phd I mean I want to do psychotherapy and have a strong background in psychology. I don't want to practice like an MD - doing 10 minute med checks and DSM checklist diagnosis - I disagree with the entire philosophy (biopysch) that underlies that. By and large I am not a fan of using pharmaceutical drugs in mental health. However I am interested in drugs that may help patients become more aware of and face their problems. Very interesting to me is the research being done with Ibogaine and ayahuasca for treating addiction for example.

I'm not very familiar with PCMH, but it sounds vaguely familiar. I'll definitely look into it.

 

[Dirkwww]

Guys thanks for the thoughts - really helpful.

@bmedclinic When I say I want to practice psych like a phd I mean I want to do psychotherapy and have a strong background in psychology. I don't want to practice like an MD - doing 10 minute med checks and DSM checklist diagnosis - I disagree with the entire philosophy (biopysch) that underlies that. By and large I am not a fan of using pharmaceutical drugs in mental health. However I am interested in drugs that may help patients become more aware of and face their problems. Very interesting to me is the research being done with Ibogaine and ayahuasca for treating addiction for example.

I'm not very familiar with PCMH, but it sounds vaguely familiar. I'll definitely look into it.

These thoughts pretty much sum up why i am not going into psychiatry and i am pursuing clinical psychology(research as well).

 

[Doctor Eliza]

- I disagree with the entire philosophy (biopysch) that underlies that. By and large I am not a fan of using pharmaceutical drugs in mental health. QUOTE]

This part really astounds me. After practicing for 4 years full time as a clinical psychologist, I am becoming more and more aware of the invaluable role that medications play in treating mental health concerns.

There are without a doubt people who experience conditions that are very biologically driven. Insight or techniques alone cannot keep everyone well. Encouraging them to try to live without medication sets them up for failure and disappoinment. This is not to mention the shame of feeling like they are weak-willed or of poor character for struggling with the things that they do and not being able to manage without medication.

In addition to the biologically driven folks, there are many people that by the time they reach a therapist are so depressed they they can get very little out of treatment. These people will be much more successful if medication can lift their mood so that they are able to work on issues.

I don't think that all people with mental health concerns need to turn to meds as a first option. However, I do think there is a very large group of people who benefit from treatment from a biopsychosocial perspective.

Right now there is a huge shortage of competent psychiatrists who can determine when a patient will benefit from medication and what strategies would be most helpful. There are a lot of GP's and incompetent psychiatrists throwing tons of inappropriate meds on distressed individuals. You have the opportunity to be a thoughtful psychiatrist who uses meds only when needed and provides psychological treatment as well. From where I sit, that sounds like a great opportunity and it is hard to understand why you'd turn your back on that.

Dr. E

 

[subalpinesun]

@DrE Really appreciate your thoughts. Your points are well taken. I guess what you wrote in your last paragraph is what concerns me the most. Psychiatry seems to be going in the direction of just throwing meds at everyone. I don't want to spend 4 years learning that kind of discipline. I'm afraid I'll come out empty handed in terms of my psychotherapeutic ability and foundation in psychology. If I get my MD and then pursue a PhD in psych I wonder if I wouldn't be getting the best of both worlds. Unless I can find a residency that really emphasizes psychotherapy/psychoanalysis.

 

[subalpinesun]

@psycscientist Point also well taken. Yes, what I mean is psychodynamic. Although paychoanalysis interests me at the level of simply understanding how the mind works more than as a treatment.

 

[ela]

Id agree with many of the above; finish the residency, ideally in a place that at least has some solid psychothearpy training, and then pursue the analytic/archetypal (yeah pacifica!) etc work youre more interested in.

I would encourage you to check out the residency at the Medical College of Wisconsin. I know for a fact that many of the training directors are practicing psychoanalysts and they provide extra opportunities for didactics and supervision in this area. PM me if you'd like some more info/names.

 

[psychRA]

By and large I am not a fan of using pharmaceutical drugs in mental health.

I assume you're interested in working solely with high-functioning patients, then? If so, I'd imagine that there's a solid market out there for what you want to do (and I would also be uninterested in doing 10-minute med checks all day), but it would absolutely restrict you to a specific range of symptom severity.

I understand that some people are skeptical of psych meds for things like depression and anxiety. I don't agree with those people, but as long as you're upfront with patients about the fact that you don't intend to prescribe medication, and you're willing to refer patients whose symptoms are too severe to respond to therapy, I guess that's your decision.

However, having worked extensively with patients with very severe mental illness, I can assure you that no amount of psychotherapy is going to help a schizophrenic patient in the throes of a hallucination. Ditto to someone in the midst of a mania-induced psychotic episode. These symptoms are not logic or knowledge deficits, and no amount of processing or reflecting is going to address them. That's not to say that people with severe mental illness can't benefit from psychotherapy; they absolutely can, but for the vast majority, meds are a necessary and lifelong part of the equation. In my view, any mental health practitioner who doesn't support the use of medication has no business treating severe mental illness.

I'm guessing that you weren't including patients like mine in your statement, but I'd encourage you to be mindful of making such broad statements. When I hear someone say that they "don't buy" the use of current psychiatric medications, it really sets me on edge.

 

[subalpinesun]

@psychRA thanks for your helpful thoughts. Yes, you are correct. My main interest would be in working with intelligent, relatively high-functioning individuals with some ability for self reflection and personal insight.

 

[erg923]

ability for self reflection and personal insight.

Do you view this as their job..or part of yours?

 

[subalpinesun]

@erg923 Thanks for the question. I would say it's both of ours. I have to be able to 'see' the patient but it's not enough if the patient can't come to a better understanding of themselves and 'see' themselves differently as well.