MSW versus MD versus MBA -- for a 24-yr-old Psych major

[BX1959]

This is one of the most important questions I've ever asked myself, so bear with me!

I'm a 24-year-old guy who graduated with a psychology degree back in 2013. Since then, I've had a very good few years figuring out what I would like to do as a career. This included a year discerning a religious vocation in Chicago (I ultimately felt called to marry, and hence leave the formation program) and a year as an AmeriCorps VISTA member (which I'm doing now).

I thought I had my future figured out: I would get an MSSW (from UT-Austin, which accepted my application), and have a rewarding career helping people in need. My plan was to be a LCSW and focus on counseling or therapy, perhaps moving into private practice.

And then I met an amazing woman. Both of us want to have a large family, and she wants to be a stay-at-home mom and homeschool her kids, which I think is fantastic (but if she changes her mind, that's fine too). We were talking about the finances of marriage and family life, and I realized that while 50K or 60K is a decent median salary for clinical social workers, it may not be enough for a single income earner. Hence, I started to reconsider social work simply on salary grounds. (Helping others is a wonderful calling, but (A there are more ways to help others than social work, and (B what good will I be as a social worker if I can't support my own family?)

And then I reconsidered social work on another ground: I wondered (PLEASE bear with me, I mean no offense to social workers -- many of you are living saints and I am a naive 24-year-old) if social work would make full use of my academic and intellectual ability. I had a 2310 SAT score (760 math, 770 critical reading, 780 writing). On the GREs, I got a 169 on the verbal section, a 5.0 on the analytical writing section, and a 160 on the quantitative reasoning section. (I didn't study extensively for this test, and I believe it showed on the quantitative section.) If nothing else, I think these scores, along with going to a school where the acceptance rate is about 20% and finishing with a 3.63 GPA, show that I have the potential to do well in medical school. I did reasonably well in the hard sciences in high school, but I didn't excel, either (I was thinking of pursuing creative writing at the time, and I had very little interest in hard sciences. Also, in full disclosure, I dropped out of calculus, but I was going through a difficult period at the time that I've since resolved.)

I have a tendency to take the easier way out, to avoid opportunities for fear of failing, and to doubt myself. I desire to diagnose and treat mental illness, and social work seemed to be the 'easier' path. I now recognize that psychiatrists can offer a wider range of treatment options than can social workers, counselors, therapists, and psychologists. In that case, part of me asks: if I really want to help people overcome mental illness, why not go 'all the way'?

In a very broad, almost philosophical sense, I would like to push myself to the fullest in an intellectual and academic sense. I want to make full use of the talents and gifts that I have, and to be able to serve those with mental illness to the greatest extent possible. I think medical school, above practically any other field, will make that possible.

But I realize that psychiatry would be a long, expensive, difficult road. It would involve a post-bac (since I only took one hard sciences course in college), four years of medical school, then four years of residency. I would be 'all done' by 35, at the earliest. As someone who wants to have a large family, that would entail having kids pretty late (and inevitably limiting our family size). It would be asking a ton of my future wife too; she would have to provide for me and we'd probably have to wait to have kids.

Then again, I would still earn much more over my career as a psychiatrist than as a social worker, even if I started the former much later. And supposing that I retire at 65, my starting medicine five years later would mean the difference between a 35-year career (if I went into medical school right out of college) and a 30-year career (if I started my post-bac in 2016). That's not a huge discrepancy, and I think those 5 'in-between' years will have been well spent.

The 'red flags' I see in my case are threefold: (1 I don't have much intrinsic interest in the natural sciences, (2 aside from a very brief spell in college, being a doctor hasn't really appealed to me, and (3 the financial side is a significant factor in my decision. I don't wish to become rich, but I'd like to be able to support 5, maybe 7 kids, on a single income.

I discussed all of this with my girlfriend; her brother is in his second year of medical school and will marry in December, and she's in nursing school -- so she's well aware of the downsides of the medical field. I also talked about it with my mom and dad, and briefly discussed the idea with my sister. My girlfriend and mom both thought it was worth exploring; my dad and sister, meanwhile, didn't think it was a great idea. My girlfriend and dad both suggested that I look into an MBA. At this point, I have very little interest in business, but I realize it's something I should look into.

At this point, my questions (for you) are:
1. Does medical school/psychiatry seem like a good career choice, or am I just being idealistic/foolish?
2. What are my post-bac options, specifically in Texas (where I'll have in-state status come February 2016), and what should I be doing right now to prepare for the post-bac and the MCAT?
3. When can I realistically expect to complete my residency? Does 11 years/35 years sound like a good estimate?
4. Should I be worried because I don't have a burning passion for the natural sciences, or because my interest in being a doctor is coming pretty late?

Thank you so much for your advice and help.

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[SpartanWolverine]

It sounds like you want to go into medicine to "help people" and make money. Two bad reasons. So, from the vibe I got from your post I'll be pretty blunt here:
1) You're being idealistic. You're just thinking about the endpoint (money, influence to help) without truly understanding the process.
2) You have plenty of post-bacc options. However, that's getting ahead of yourself. Have you ever volunteered in a hospital? Shadowed? Been exposed to medicine at all? You might want to spend some time exploring medicine before you start to commit to years of coursework.
3) You can expect to complete a psych residency four years after starting it.
4) Yes, you should be worried. I didn't read anything in your post that made me think you really wanted to go into medicine. It sounded like you were trying to justify it by saying you like to help people and want to make good money. I would recommend you continue your current career path and get a master's. Considering you want to start a family... 2+ years of coursework, 4 years of medical school, and 4 years of residency (plus monstrous debt) would be an opportunity cost approaching $1M.

Anyhow, best of luck! This is just my opinion, so don't take it too seriously.

 

[BX1959]

Thanks for the excellent points. Blunt advice is exactly what I need, so lay it on!

I see two different opportunity costs here. There is indeed a huge opportunity cost to medical school relative to the MSW program. But once I'm working as a psychiatrist -- let's say between the ages of 35 and 65 -- the opportunity cost of social work is even larger, since I'd probably be making ~100K less each year, for 30 years.

If you could explain the post-bacc options in general, or provide a link, that would be great. I'm trying to figure out whether there are 'career changer' post-baccs in Texas, or just programs designed to increase your GPA.

Volunteering in a hospital sounds fantastic. What sort of volunteer or shadowing opportunities would be available for someone in my position? (I live in Houston, so the Texas Medical Center is right nearby.) At this stage especially, I'm also thinking of doing some informational interviews with psychiatrists in the area.

I too wonder if my heart is truly in medicine. But perhaps if I pursue volunteer/shadowing opportunities and spend time talking with psychiatrists, I'll discover that it was my calling all along.

 

[NonTrad16]

I would contact physicians (in and outside fields of immediate interest--you can't know what opoortunities will arise, so it's good to stay open minded) to discuss their work, your goals, and arrange to shadow as available. The three careers are wildly different and truthfully you don't seem passionate about them... That's not to say you can't do it, a surgeon a shadowed pursued it "practically", but he also brought up his 401k whereas none others have.

Also, the forum is extensive with a FAQ at the top and a search function, so you can likely gather an hours worth of info on things like post bacs, etc with a little legwork in much less time.

 

[jamcat]

In order to get into medical school you'll need a ton of shadowing and clinical volunteering. Just front-load it so you can decide whether medicine is something you want to pursue. I think that should be your first priority (start now!) so you can make a more informed decision. Informational interviews might be marginally helpful, but actually amassing clinical volunteer hours will be much more telling. (And make sure they're clinical, where you're actually dealing with patients. Some pre-meds find out that they actually don't like working with patients, and that's best to find out sooner rather than later )

Also, having taken only one hard science class in college means you don't really know what a full load of science classes is like. It sounds like you're aware of this. Not having a particular interest in science is concerning, because that's what you'll be eating and breathing for the next decade of your life. You'll likely be doing some sort of science research to get into medical school or get a residency. You've gotta like science, and you've gotta be able to do science well.

It sounds like you'd be going into medicine more for the money than anything else. Others here can comment with more expertise on that matter than I can, but I'll say that's rather uninspiring and unsettling. Also consider the hours you'd be working to make that money--if you're making the money to support 5 or 7 kids, the hours you'd be working would preclude you from ever seeing your kids. Which maybe is okay with you.

In terms of working up to your potential, it doesn't matter how academically gifted or inherently bright you are if you're not working on something you're passionate about. You'll be able to use your skills to their fullest extent in whatever career you choose. Identify a problem you're passionate about fixing and fix it, and I guarantee you'll use every last drop of ability regardless of your education.

As far as post-baccs are concerned, you don't need a program. All you need is to take whatever pre-requisite classes you need to apply for medical school.

Finally, I'll just add anecdotally that, as someone in my late-20s who has witnessed my high school and college friends pursue all sorts of career paths, if you're looking for a high, stable salary sooner rather than later, and that is a major motivation for choosing a career, the MBA seems to be the way to go. I know absolutely nothing about MBA programs other than that.

 

[BX1959]

Thanks for the thorough, insightful response. Two questions: if I don't need a post-bacc, where do I take the pre-requisites? At a community college? At a university? I'm in Houston, if it makes any difference.

How do I go about clinical volunteering/shadowing? Is it as simple as calling up/e-mailing psychiatrists and explaining that I'd like to know more about the field?

I like to think that my interest in psychiatry derives from my similar interest in clinical psychology and clinical social work: all three are fields that involve diagnosing and treating mental illness. But psychiatrists have more means available to treat patients than psychologists or social workers -- namely, the ability to prescribe medication.

 

[jamcat]

Doesn't matter where you take the pre-reqs. Some say it's best to avoid community colleges; some say it doesn't matter. If you think you might be going for top medical schools, it's probably best to just take the pre-reqs at a 4-year school. Many schools will have some version of a Continuing Ed division where you can just register for whatever classes you want. Others might require you to enroll as a second degree student, in which case you enroll, take what classes you need, and then just never finish the degree

You can email psychiatrists, although I don't have as much experience in that field and am not quite sure if that specialty is quite as amenable to clinical volunteering or shadowing as others. A common way to get clinical volunteer hours is at a local hospital. Many hospitals have volunteer programs with info online.

I think this is also where talking to psychiatrists will be helpful. I'm not sure that the ability to prescribe medication is, as you think it is, expanding the arsenal; my sense is that a psychiatrist simply uses a *different* arsenal than psychologists or social workers and are there for a different purpose. One older (60s-ish) psychiatrist even told me that he wouldn't have gone into psychiatry if he were choosing a career today because he likes talking with patients, but today he mostly just writes prescriptions. He said if he had to do it over, he would have been a psychologist, reflecting the concept of different arsenals rather than expanded ones. This is just the perspective of one psychiatrist I've spoken with, but it's definitely worth talking to a variety of psychiatrists about. Maybe your interests lie more in medication than in other forms of therapy, in which case the MD would be more appropriate than the other options.

 

[BX1959]

It looks like many of the large Houston-based hospital systems have clinical volunteer opportunities, which is fantastic. I can apply to some this week. I suppose even if the volunteer work isn't psychiatry-based, it will still be great for learning more about the medical field, and of course for applying to medical school.

Houston has a few post-bacc programs, such as the University of St. Thomas's. Part of me is attracted to the structure and faculty support that those programs offer (including LOR opportunities), but I recognize they'll be more expensive, especially if the school is private. Honestly, if it would mean a significantly better chance of getting into medical school, I'd be willing to pay the extra money.

My AmeriCorps work is 9-5, Monday to Friday, with some weekend commitments included. Would it be at all feasible to take a few evening classes this year? My AmeriCorps program finishes in February 2016, and by then I'll have in-state status.

Another question: will it help at all that I have a B.A. in psychology when it becomes time to apply to medical school? Some sites say that a Psych degree is one option for applying to medical school (provided you've taken the necessary science courses, of course). In my case, will it at least be more useful than an Art History or Latin American Studies major?

One thing is for sure: by the time I would apply for medical school, I'll have a much better idea of whether I want to be a psychiatrist than I do now!

 

[Apollo1]

If nothing else, I think these scores, along with going to a school where the acceptance rate is about 20% and finishing with a 3.63 GPA, show that I have the potential to do well in medical school

(since I only took one hard sciences course in college)

With all sincerity, you might be getting ahead of yourself.

Another question: will it help at all that I have a B.A. in psychology when it becomes time to apply to medical school? Some sites say that a Psych degree is one option for applying to medical school (provided you've taken the necessary science courses, of course). In my case, will it at least be more useful than an Art History or Latin American Studies major?

No single degree possesses more objective utility than another; it's all dependent on what courses you take.

How do I go about clinical volunteering/shadowing? Is it as simple as calling up/e-mailing psychiatrists and explaining that I'd like to know more about the field?

Start with doctors you actually know (i.e. you're their patient). You'll probably get better reception from them vs. cold-calling a stranger who doesn't know whether you're sane or have other motivations.

There seems to be a lot of focus here on salary/marriage/providing for family. You should probably create a list of pros and cons regarding medical school/residency, etc. vs. going for an MBA, etc. to see which one you'd have a better fit in.

 

[BX1959]

Thanks for reminding me about the PsyD/PhD option!
I lost interest in this field at one point, since I figured (A if it's as hard to get into as medical school, and (B the pay is less, and (C you can do less, why not go ahead with psychiatry?
Correct me if I'm wrong, but some PhD programs in clinical psych are ridiculously hard to get into. The acceptance rate into UT's clinical psychology program is 2.94%. Yes, I put the period in the right place. But I haven't looked extensively into PsyD programs. I like that those are practice-focused and are a bit shorter, but even then you'll have a residency of 1 to 2 years.

As far as salary goes, on Payscale, the average salary reported by psychologists in private practice is $260,000. Now that's an average of just 22 reports, but that's more than many psychiatrists make.

If it is indeed the case that prescribing medication takes up the majority of psychiatrists' time, whereas psychologists focus more on counseling and therapy, then I ought to take a more serious look at clinical psychology.

 

[ZX10R]

Since your primary focus is money, it would be better to go the PsD/PhD way. Realistically it'll take you 2-3 years to get to med school (are you going to be taking loans for these years); whereas you can apply for the other programs now, or if its to late early next year. You've already taken then GRE, and I assume that the programs have such low acceptance number is because there are a ton of psych majors every year and lots of them apply. I think most med schools in Texas have <5% acceptance even for in-state residents. Anyways what I'm trying to get at is that if your going to get in debt before medical school, and then have to take out loans to pay for medical school; it will be a long time before you start making money. Also, being a doctor is not a 9-5 outside of select instances. There's always paperwork and other BS that get added every year.

 

[BX1959]

There's a lot about the clinical psychology route that I find attractive. But issue is that I don't have any research/volunteer experience under my belt, not even a thesis. The folks on the psychology forum say that I'll need to build up some research experience, even for the PsyD. I'm not sure that PsyD programs are easy to get into at all. Your friend sounds like she was great candidate -- I'm guessing she had done quite a bit of research and volunteering? There are some programs that have relatively high acceptance rates (e.g. the professional schools), but everyone is cautioning me against that route.

My parents have said that they'll pay for two years of grad school, which could mean a post-bacc program. Medical school would bring lots of debt with it, no doubt. But this will most likely be the case for a PsyD also.

I never thought I would say this, but it seems like psychiatry is the safer, more practical route than clinical psychology. I say this with regards to employment, and even to admissions. Just as med students have residencies to worry about, psychology students have internships to worry about. And my interest is not really in research, which I think makes up a big part of even PsyD programs.

Yes ZX10R, I acknowledge that money is a significant factor in my decision. But I've had a long interest in the mental health field -- since my freshman year of college, really. And psychiatry would allow me to diagnose and treat mental illness with a scope unparalleled in healthcare.

Please keep the advice coming, everyone -- this has been very helpful so far.