Med Student Looking For Advice

[deleted1045228]

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Hi! Second year medical student here, looking for advice on different psychology career paths.
Some background- I have no experience in psychology at all. My undergrad degree was in Biomedical Sciences and I was basically the traditional pre-med student. Over time, I realized that medicine isn't my "true passion", but a combination of external forces (parental pressure, timing, etc.) led to me starting and intending to fully complete medical school. I'm not too keen on doing traditional "clinical" medicine like everyday doctors do; this has led me to toy with the idea of not doing a traditional residency or doing one and not practicing after.
Aside from all of that, I've come to realize that the field of psychology is incredibly interesting to me and out of all the science disciplines out there, I would not mind pursuing a career in psychology. I envision myself counseling and guiding clients/patients over anything else, which is why psychiatry is not an attractive option to me. My basic research of psychology career paths led me to see clinical psychology PhDs or PsyD degrees as potential options.
My questions are (a) what can I do now to learn more about clinical psychology and (b) what degrees/career paths are out there that are realistic options for me to do after medical school/whatever residency I decide.

Any and all advice is appreciated! Thanks in advance.

 

[AbnormalPsych]

If you want a clinically focused career doing therapy (rather than assessment, research, etc), I were you, I'd complete this med school journey and become a psychiatrist. Seek out as much therapy training as possible along the way. Find mentors that do this in hospitals and private practice. Take extra CEUs in the world of psychology. There seem to be a group of folks in the psychiatry forum that do more therapy than their peers. As long as you aren't going to be miserable finishing the path you are on, I think it allows you the compromise of financial stability (not to mention walking away from massive medical school loans to take a lower psychologist salary) and the ability to do what you want still.

What is the ideal patient you'd like to work with?

 

[deleted1045228]

If you want a clinically focused career doing therapy (rather than assessment, research, etc), I were you, I'd complete this med school journey and become a psychiatrist. Seek out as much therapy training as possible along the way. Find mentors that do this in hospitals and private practice. Take extra CEUs in the world of psychology. There seem to be a group of folks in the psychiatry forum that do more therapy than their peers. As long as you aren't going to be miserable finishing the path you are on, I think it allows you the compromise of financial stability (not to mention walking away from massive medical school loans to take a lower psychologist salary) and the ability to do what you want still.

What is the ideal patient you'd like to work with?

Thanks for that advice, definitely helped clarify things for me.
I see myself working with patients that are going through life changes or are in acute situations of stress (school, divorce, etc.). Basically, just everyday therapy (if that makes sense).

 

[PsyDr]

You have a few options:

1) complete medical school, do a psych residency, and then do whatever you want in that area. There has been a shift towards renewed interest in psychotherapy in psychiatry that might support your interest. If you really want to do more psychotherapy, you could get extra training at one of the institutes like Beck or a psychoanalytic institute. The only thing you won’t be trained to do is testing.

2) complete medical school, ditch residency and practice psych in one of those states that doesn’t require one. There’s one state that has a junior physician thing. And that neurology resident that freaked out on an Uber driver,destroyed his car, got fired from residency, and offered a non apology ended up opening a psych practice in Florida without a residency (afaik).

3) complete medical school, avoid residency, go into research, teaching, or pharma consulting. Many industries will basically hire anyone with an MD.

4) #1 but then there’s this one school in like California that has a PhD in psychoanalysis. That would get an extra credential.

5) #1 but go into practice with a bunch of psychologists (a psychiatrist trying to join a psychologist practice would be an extremely simple thing). Create some wrap around treatment, meet in case conferences.


Most psychologists are in clinical practice. In general clinical practice is confined to testing and psychotherapy. And I guess prescribing if you wanna count the ~150 psychologists doing that nationwide. In clinical practice, there is a high skewing towards psychotherapy.

In psychotherapy, there is a skewing towards “the worries well” (I.e., generally higher functioning people, who have a job that pays well and has good insurance, that have some depressive and anxious symptoms). Some psychotherapists treat more severe mental illness though, and a smaller minority treat individuals who are suffering from the psychological results of a medical illnesses.

A slight minority of psychologists do testing instead. These problems skew towards medical illnesses of varying severity.

A smaller minority of psychologists practice research.

 

[deleted1045228]

You have a few options:

1) complete medical school, do a psych residency, and then do whatever you want in that area. There has been a shift towards renewed interest in psychotherapy in psychiatry that might support your interest. If you really want to do more psychotherapy, you could get extra training at one of the institutes like Beck or a psychoanalytic institute. The only thing you won’t be trained to do is testing.

2) complete medical school, ditch residency and practice psych in one of those states that doesn’t require one. There’s one state that has a junior physician thing. And that neurology resident that freaked out on an Uber driver,destroyed his car, got fired from residency, and offered a non apology ended up opening a psych practice in Florida without a residency (afaik).

3) complete medical school, avoid residency, go into research, teaching, or pharma consulting. Many industries will basically hire anyone with an MD.

4) #1 but then there’s this one school in like California that has a PhD in psychoanalysis. That would get an extra credential.

5) #1 but go into practice with a bunch of psychologists (a psychiatrist trying to join a psychologist practice would be an extremely simple thing). Create some wrap around treatment, meet in case conferences.


Most psychologists are in clinical practice. In general clinical practice is confined to testing and psychotherapy. And I guess prescribing if you wanna count the ~150 psychologists doing that nationwide. In clinical practice, there is a high skewing towards psychotherapy.

In psychotherapy, there is a skewing towards “the worries well” (I.e., generally higher functioning people, who have a job that pays well and has good insurance, that have some depressive and anxious symptoms). Some psychotherapists treat more severe mental illness though, and a smaller minority treat individuals who are suffering from the psychological results of a medical illnesses.

A slight minority of psychologists do testing instead. These problems skew towards medical illnesses of varying severity.

A smaller minority of psychologists practice research.

Thanks for all of this. It definitely helps a lot. In your opinion, which option would allow me to do more counseling related work? I see myself thriving in that environment more than anything else.

 

[beginner2011]

Thanks for all of this. It definitely helps a lot. In your opinion, which option would allow me to do more counseling related work? I see myself thriving in that environment more than anything else.

Option 1 would be the most likely to provide relevant professional and technical training in psychotherapy. Results could vary substantially depending on residency. My understanding is that some psychiatry residencies may provide substantial psychotherapy training, while others may provide almost none.

Edit: Relevant thread from a few months ago in this forum: Do psychiatrists provide psychotherapy?

Also, from Psychiatry forum: Psychotherapy training — Bare minimum vs. extensive?

 

[AbnormalPsych]

And that neurology resident that freaked out on an Uber driver,destroyed his car, got fired from residency, and offered a non apology ended up opening a psych practice in Florida without a residency

Florida man?

 

[summerbabe]

I see myself working with patients that are going through life changes or are in acute situations of stress (school, divorce, etc.). Basically, just everyday therapy (if that makes sense).

One thing to consider is whether you'd enjoy doing short-term work (e.g., 1 to a few sessions), time-limited work (e.g., 12 weekly sessions to extensively work on a goal and then terminate), or working with people long-term.

Does your school have a robust alumni network that can help you connect with graduates in psychiatry, especially those who may do more therapy and how they ended up in those positions? This can help prepare you for your psychiatry rotation.

I work in the VA where there are a variety of psychiatry positions. From my experience in 3 different VA systems, residential/inpatient settings might have more therapy-oriented clinical interactions (versus outpt med management where you may see a typical patient once for 30 minutes every 2-6 months).

 

[deleted343839]

I'm not recommending that you cut your losses after a year of med school, but I would like to describe what it might be like if you did so you'll be aware. First, I would recommend attending only a funded, university-based clinical or counseling psychology PhD program. Psych admissions committees are looking for somewhat different experiences than medical school ad comms. For one, research experience is much more important. You also need to have completed some undergraduate psychology courses (generally, introductory psych, abnormal, research methods, statistics, maybe experimental psych) if you don't have a degree in the discipline. You would also need to take a different admissions test (the GRE). If you are weak on any of these fronts, you'll need to delay your application for a year while you fix what you need to improve.

Once you're admitted to a program, your typical length of training in graduate school is 5-7 years. The final year will be a 1-year internship, which is a bit like a residency in that you apply to multiple sites, interview at all of them (many in person -- though who knows what will happen now), go through a match, and then move for a (poorly compensated) 40+ hour/week position.

Some, but not all, states require an additional year of supervised postdoctoral experience before you are eligible for licensure. This is falling by the wayside as more states opt to remove this requirement for licensure, but unless you know you want to practice in a specific state that doesn't require it, you should be prepared for another year to complete your training. Good news - salary goes up at this point, but you'll be lucky to break $50K.

All the while, you will be living on a graduate stipend typically in the low-mid $20s, plus whatever you might be able to earn on the side (though you won't have a lot of time for outside work).

I am not saying this to persuade or dissuade, just to inform.

 

[AbnormalPsych]

I'm not recommending that you cut your losses after a year of med school, but I would like to describe what it might be like if you did so you'll be aware. First, I would recommend attending only a funded, university-based clinical or counseling psychology PhD program. Psych admissions committees are looking for somewhat different experiences than medical school ad comms. For one, research experience is much more important. You also need to have completed some undergraduate psychology courses (generally, introductory psych, abnormal, research methods, statistics, maybe experimental psych) if you don't have a degree in the discipline. You would also need to take a different admissions test (the GRE). If you are weak on any of these fronts, you'll need to delay your application for a year while you fix what you need to improve.

Once you're admitted to a program, your typical length of training in graduate school is 5-7 years. The final year will be a 1-year internship, which is a bit like a residency in that you apply to multiple sites, interview at all of them (many in person -- though who knows what will happen now), go through a match, and then move for a (poorly compensated) 40+ hour/week position.

Some, but not all, states require an additional year of supervised postdoctoral experience before you are eligible for licensure. This is falling by the wayside as more states opt to remove this requirement for licensure, but unless you know you want to practice in a specific state that doesn't require it, you should be prepared for another year to complete your training. Good news - salary goes up at this point, but you'll be lucky to break $50K.

All the while, you will be living on a graduate stipend typically in the low-mid $20s, plus whatever you might be able to earn on the side (though you won't have a lot of time for outside work).

I am not saying this to persuade or dissuade, just to inform.

And this is assuming the OP can even get into a program. Many programs will have concerns regarding OP dropping out of a med school program and wonder if the same might happen if admitted. Even if OP was competitive, it may take several years to get in, as acceptance rates can be quite low (<5%) for good programs.

 

[tr]

Agree with above. Clinical psychology programs are pretty competitive, looking for a different profile than med schools, and would take a significant amount of redirection and effort. Plus it's like a six year degree with postdoctoral training on top of that. It would be harder, longer, and possibly even more expensive to reroute that way than to finish the route you're on. If you are a second year med student you have 2+4 years left to finish med school and complete psychiatry residency. For psychology grad school you'd need at least 1-2 years to retool your CV and reapply, and then 6-7 years of training after that, for a salary that will be about 1/4 to 1/2 of what you would make as an MD, on which you would still have to pay back whatever debt you've already accrued.

Given where you're at I would say just finish out med school and do a psychiatry residency with a strong psychotherapy emphasis. You will be able to do most of what a psychologist would do (barring assessment/neuropsych) and get paid more for it. If you want to have a private practice where you only do psychotherapy, you can totally do that as a psychiatrist. (Would be harder to do this as salaried gig as the paper pushers will want you to do med management.)

I'm an academic psychiatrist and I have a lot of psychologist colleagues who are on extremely similar career paths to mine. The main difference seeming to be that they are paid less, and possibly face greater levels of competition since they are coming from a degree path with an explicit research emphasis and less of a financial disparity between academics and private practice, whereas most of the people I trained with were very happy to bail out of academia and head to private practice for 2x the income.

 

[chicandtoughness]

As someone who does psychotherapy (masters level clinician tho) and is trying to make to jump to med school, I actually urge you to stay put, finish out med school, and then decide from there. Quitting med school now is probably going to result in a year or two to gather research experience so that you can make it into a PhD program, with very low chances of getting (possibly lower chances than med school, depending on what programs you're looking at). So really we're looking at:

- 2-3 years med school left (it was unclear whether you just finished MS2 or you're starting MS2) + 3 years psych residency = 5-6 years of input for $250k+ starting salary
- 2 years research experience + 5-6 years PhD (assuming you get in first try, which is sadly not the typical case) = 7-8 years of input for ~$75k starting :')

Psychiatrists can do talk therapy! I have a close colleague who is on staff part time at a local hospital (your usual med management stuff) and then sees patients in private practice (for traditional psychotherapy) 3 days a week. He's having a blast.

4) #1 but then there’s this one school in like California that has a PhD in psychoanalysis. That would get an extra credential.

No longer a thing. California laid the smackdown on all the PhD/PsyD programs in psychoanalysis a couple years ago. They're all scrambling to regroup. They have intentions of reformatting their programs and reapplying to be able to offer the degree, but that was in 2018 and there hasn't been movement, so I'm not hopeful.

There is always BGSP though, if you want the PsyaD (Doctor of Psychoanalysis).