Need a little guidance

[IamOat]

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Hello,

As a little background on myself I'm a psychiatric nurse practitioner currently working in geriatric psych and before this family medicine and home health. I have a masters and bachelors in nursing. I'm been kicking around the idea of going to med school to become a psychiatrist, going for my MPH, and now thinking about psychology. I like listening to patients and it gives me a sense of fulfillment I haven't been able to find in my other positions. I've been looking at psychology schools but the prerequisites for entry are all over the place and I'm also not sure if I'm prepared to study at the doctoral level.

If I don't have a degree in psychology can I be accepted into a PsyD program? I realize PhD programs are also clinically oriented but I can’t take time off from work to pursue research, am probably not the most competitive student, and strictly want to focus on clinical practice.
How do I know I'm prepared to start working at the doctoral level? Will my current education help? Should I start taking some psychology classes at the local CC?
Do I need a heavy math background? I've worked up to the precalculus level and am retaking statistics.

Thank you for any input.

 

[FreudianSlippers]

It's not so much PsyD vs PhD as it is professional schools vs traditional brick and mortar schools. Any legit PsyD is going to take up as much time as a PhD and will be similarly competitive, although you are right that the research component will be less emphasized. If you go the professional school route, you are looking at massive cohorts and 200,000 dollars in debt. I'd first be curious as to why a doctoral program over another degree? You can do exactly the same clinical with with a LSCW or LMFT degree (e.g. "listening to patients"), with half the time and money. I'm not saying don't get your doctorate degree, just to put in some thought if this is the best route for you at this point in your life?

 

[deleted343839]

I've known a handful of registered nurses who became psychologists and went on to do research, program development, and other interesting things.

A first question is whether you might be able to find a position that better suits you where, perhaps with some additional training and mentoring, you could provide more face-to-face counseling. It is an unusual model but it exists.

A second question is the rationale for a degree in psychology versus another professional degree such as counseling or social work. It's legitimate to study psychology with the goal of becoming a clinician, but you need to be able to articulate the why.

Honestly, if you are able to put together a competitive application I would encourage you to consider the medical school pathway long and hard.

 

[psych.meout]

OP, is this you?

 

[IamOat]

OP, is this you?

Yep that's me! I like to go to multiple places for these things.

 

[IamOat]

It's not so much PsyD vs PhD as it is professional schools vs traditional brick and mortar schools. Any legit PsyD is going to take up as much time as a PhD and will be similarly competitive, although you are right that the research component will be less emphasized. If you go the professional school route, you are looking at massive cohorts and 200,000 dollars in debt. I'd first be curious as to why a doctoral program over another degree? You can do exactly the same clinical with with a LSCW or LMFT degree (e.g. "listening to patients"), with half the time and money. I'm not saying don't get your doctorate degree, just to put in some thought if this is the best route for you at this point in your life?

Looking at ROI I would never take out that much in loans for what psychology pays. 100k though and work in a FQHC for 2 years to forgive 50k of that and 20k every 2 years thereafter? Sure I'd do that no problem.

This may come down to feelings of mid-level inadequacy. I don't know how this works in the psychology world but the majority of MD's/DO's I've met do not look favorably at NP's/PA's. They see us as a budget option that provides unsafe care to patients who would be better served by a doctor. Is that sometimes the case? Sure if you have a patient with "CAD s/p PCI x 3, CHF, DM II, and ESRD "who's one breeze of wind away from being hospitalized again. For the vast majority of things though like simple hypertension and uncomplicated type 2 diabetes we're more than adequate however then if for whatever reason something goes wrong and we have to refer the doctors will then bust out their "our training lets us recognize the zebras" line like we're not trained to recognize when something is going wrong or that doctors never screw up. I don't know if psychologists have the same relationships with their mid-levels but it's probably the biggest downside of my occupation. Some doctors do respect you for the work that you do but it's about a 60/40 split. I know this sounds like I just want a doctorate for the respect but if that's what it takes to reach that 40% so the patient can benefit then I'll do it.

I was asked in my Reddit post as well why I want a doctorate if all I want to do is therapy. My question then is what can a psychologist do that a LSCW or LMFT cannot? If there's going to be some barriers to full scope of practice like I face at the NP level I don't think I'd be content in the role.

 

[Doctor Eliza]

Without any research experience, you are going to be hard pressed to get into a reputable doctoral program, even a quality PsyD. People do get in without psych degrees, but there are definitely psych courses that are required. Another thing to consider is how able are you to relocate? Typically folks relocate for grad school, then again for internship, and maybe again for postdoc.

Something else to think about is whether you want to be employed with benefits or a contractor/self-employed. I’m sure others will jump in with different experiences, but in my locale, it would be easy to find employment with benefits as a CNP but much less so as a general psychologist. We opened a new psychiatric hospital a few years ago. I looked at the job postings. There was not one for a psychologist. Every position was for a prescriber or an MSW/LPC. Would you want to continue to rx or just do psychotherapy? What is your ideal environment to work in?

I also wonder about working as a CNP in an environment that allows for 30 minute rather than 15 minute med checks. Maybe just more face to face patient time will satisfy your desire without the torture that is grad school?

Hope some of that is helpful. Good luck.

 

[IamOat]

Without any research experience, you are going to be hard pressed to get into a reputable doctoral program, even a quality PsyD. People do get in without psych degrees, but there are definitely psych courses that are required. Another thing to consider is how able are you to relocate? Typically folks relocate for grad school, then again for internship, and maybe again for postdoc.

Thank you for the reply. I find the idea of research daunting mainly because I think it's going to be me given a spreadsheet of numbers and made to determine chi-squares and p-values and everyone is going to find out that I'm a terrible mathematician. If I had a better idea of what psychology research is like maybe I wouldn't be putting off PhD programs so much. A day in the life of would be helpful but I haven't been able to find one. It may be that it really is my true calling!
I'd be willing to relocate anywhere within California, Colorado, Nebraska, and maybe the mid west. I can't do east coast or the south except for Texas. I have wanted to get out of California for a while.
CNP pays very well and has countless job opportunities but I'm a money isn't everything kind of person (though there are limits to that). I've been there with the 6 figure income and I was miserable. Prescribing gets pretty monotonous after a while "if x doesn't work try y or add z", you learn pretty quickly that a lot of the medications we use basically do the same thing with minute differences that only make a difference in patient's quality of life not clinical endpoints so it's all about optimization of that balance. I enjoy the therapy aspect of it much more. I also have a penchant for torturing myself 😈

 

[Doctor Eliza]

So I’m understanding you to say that you picture yourself dropping the rx’ing once you embark on the psychologist path? And you have no interest in med school?

Are you located near a decent sized university where research happens? I would start by looking at the courses required for grad school admission and taking some of those. You will probably want to take research methods and statistics ASAP. Once you have those, you can try to identify a professor who does interesting work who needs volunteers to help in their lab. At first, you will probably be doing some grunt work like data entry, running participants, etc. But hopefully you can eventually help with a research poster or something.

Research is essential to get into a non-diploma mill. There’s no way around it.

Make no mistake, this will be a long process. It will probably take 3 yrs to become competitive for a good doctoral program. Then 5-6 yrs in school. Then postdoc.

I’m surprised you haven’t gotten more responses. Good luck in your decision-making.

 

[IamOat]

So I’m understanding you to say that you picture yourself dropping the rx’ing once you embark on the psychologist path? And you have no interest in med school?

Are you located near a decent sized university where research happens? I would start by looking at the courses required for grad school admission and taking some of those. You will probably want to take research methods and statistics ASAP. Once you have those, you can try to identify a professor who does interesting work who needs volunteers to help in their lab. At first, you will probably be doing some grunt work like data entry, running participants, etc. But hopefully you can eventually help with a research poster or something.

Thank you for the reply. I don't necessarily see myself Rx'ing if I embark on this path. With that and my aversion to med school I probably wouldn't want to start down that path.

I do live near one so I'll look at what their program has to offer.

Are there any reputable unfunded or partially funded PhD programs? I just ask because it seems like the number of slots per year for funded PhD programs is very few and if some students ultimately go into research and not clinical practice wouldn't this potentially lead to a shortage of psychologists? I know there's been a lot of supplanting with mid-levels but isn't there always going to be a need for a doctoral prepared clinician much like MD's/DO's?

 

[WisNeuro]

Are there any reputable unfunded or partially funded PhD programs? I just ask because it seems like the number of slots per year for funded PhD programs is very few and if some students ultimately go into research and not clinical practice wouldn't this potentially lead to a shortage of psychologists? I know there's been a lot of supplanting with mid-levels but isn't there always going to be a need for a doctoral prepared clinician much like MD's/DO's?

The vast majority of funded PHD students go onto clinical careers.

 

[WisNeuro]

also, outside of some specialty areas, I have yet to see a shortage, if anything, many markets are oversaturated. Especially with therapy providers.

 

[Sanman]

Can I ask why you want a PhD? Not sure about your state OP, but in mine a psych NP is licensed to bill psychotherapy codes. If this is true in your state, why not open a private practice. If it is an issue of competence and training rather than license, save time and money...look into the Beck Institute or other psychotherapy training program. If it is a license issue. Have you thought about moving to a state where you are an independent practitioner? I work in geriatric psych. PM me if you have more specific questions.

 

[IamOat]

Can I ask why you want a PhD? Not sure about your state OP, but in mine a psych NP is licensed to bill psychotherapy codes. If this is true in your state, why not open a private practice. If it is an issue of competence and training rather than license, save time and money...look into the Beck Institute or other psychotherapy training program. If it is a license issue. Have you thought about moving to a state where you are an independent practitioner? I work in geriatric psych. PM me if you have more specific questions.

Tbh I don’t know yet. It’s just curiosity as to what it entails.
Edit*
It also has to do with the toxicity and unethical practices rampant in the medical community. MDs bullying their students and mid levels, RNs bullying each other, CNAs hating everyone. Being asked to make unsubstantiated diagnoses to support medication use or withhold treatment to boost numbers. Not everyone is like this but it’s not something that you go weeks without seeing. My experience with the psychology field has been more civil so maybe being a midlevel wouldn’t be as bad.

 

[psych.meout]

Tbh I don’t know yet. It’s just curiosity as to what it entails.
Edit*
It also has to do with the toxicity and unethical practices rampant in the medical community. MDs bullying their students and mid levels, RNs bullying each other, CNAs hating everyone. Being asked to make unsubstantiated diagnoses to support medication use or withhold treatment to boost numbers. Not everyone is like this but it’s not something that you go weeks without seeing. My experience with the psychology field has been more civil so maybe being a midlevel wouldn’t be as bad.

I have no doubts that your experiences are accurate, but I've also known some great providers and clinics where there is comradery and mutual respect amongst the staff and genuine empathy and good will towards the patients. I've worked in or been a practicum student in some of these places.
Before you get into anything else, it might be good to look at changing jobs and finding one of these places.

Also, it's not all puppy dogs and rainbows in psychology. There are plenty of clinics and organizations that are very hierarchical, where psychiatrists are at the top of the food chain and treat psychologists like crap, and so on downwards to mid-levels and techs. It all really comes down to organization culture and individual personalities.

 

[WisNeuro]

It also has to do with the toxicity and unethical practices rampant in the medical community. MDs bullying their students and mid levels, RNs bullying each other, CNAs hating everyone. Being asked to make unsubstantiated diagnoses to support medication use or withhold treatment to boost numbers. Not everyone is like this but it’s not something that you go weeks without seeing. My experience with the psychology field has been more civil so maybe being a midlevel wouldn’t be as bad.

This is more institutional than within specific profession. You'll find the same issues in psychology in some institutions.

 

[deleted343839]

It also has to do with the toxicity and unethical practices rampant in the medical community. MDs bullying their students and mid levels, RNs bullying each other, CNAs hating everyone. Being asked to make unsubstantiated diagnoses to support medication use or withhold treatment to boost numbers. Not everyone is like this but it’s not something that you go weeks without seeing. My experience with the psychology field has been more civil so maybe being a midlevel wouldn’t be as bad.

When I was in graduate school, during the most trying year of my training, I briefly entertained the fantasy that the culture of (academic) nursing might be a better fit for me. I don't even remember how I came to that idea. But it is interesting how things look from the outside. I took a graduate-level nursing course that seemed relevant to me, and in doing so came to my senses.

Psychologists can be extremely unpleasant to one another under the right circumstances. Psychology has a reputation for "eating its young" within academia especially, though the psychologists I now work with are mostly collaborative and fine to work with. Before you ditch your current profession for another, I would make sure that your real problem isn't your organization or environment.

 

[Sanman]

Tbh I don’t know yet. It’s just curiosity as to what it entails.
Edit*
It also has to do with the toxicity and unethical practices rampant in the medical community. MDs bullying their students and mid levels, RNs bullying each other, CNAs hating everyone. Being asked to make unsubstantiated diagnoses to support medication use or withhold treatment to boost numbers. Not everyone is like this but it’s not something that you go weeks without seeing. My experience with the psychology field has been more civil so maybe being a midlevel wouldn’t be as bad.

Something to remember, psychology, as a clinical practice, is still part of the healthcare system. Some of those issues with numbers and justifications still exist, as others have mentioned.

Taking on more debt for another degree may cause you to have to take positions like this for longer rather than being able to have more freedom to choose better positions when you are financially more comfortable.

 

[IamOat]

All things considered on whether I need a PhD to do what I want to do I am still curious about research. Will any research experience be considered or do I need to be working in a psychology lab? Where do I start with this? Cold call/email the university professors that I think are doing some interesting work or go look on Indeed.com?

 

[StellaB]

I found it easier to cold call. You can also look at local universities - sometimes they post for student RA positions, but that doesn't mean they aren't open to non-students doing some of the work. I had luck with this, as I was no longer in school when I decided to apply for PhD programs.

 

[LadyHalcyon]

I don't understand why people wouldn't encourage a person to obtain a doctorate. I work with many master's level clinicians and they are severely limited in regards to what they can do. We have many more options available to us and, in my area (more rural), we have a serious lack of providers.

I see psychology as a field adopting a greater focus on a training, consulting, evaluating, and assessment. In this model the mid-levels provide the majority of the therapy, but with doctoral level supervision. I originally attended a clinical program thinking I only wanted to do forensic evaluations. Do I still love them? Yes. But I also love therapy. What I really love is the fact my degree allows me to do exactly what I want. I can carry a caseload of 5 to 10 higher-risk clients. I can afford to do this because I can make money doing the following: supervising prac students, a variety of assessments and forensic evals, contracts with local group homes where they need me to sign their treatment plans. I also am able to be involved in the training of staff members, consulting with psychiatry, the selection of the clients for the group home etc...

My program was long. I started in 2012 and I graduated in 2018. I was only licensed a few months ago. Are all of the above job opportunities I discussed 100% "in place" after two months? Hell no! But the ball is rolling on all of those things. It is hard to predict the person you will be at the end of your doctoral program. The difference in my opinion between good and great therapy is a level of self-awareness, which occurs as a result of constant reflection and feedback from good supervisors. I understand there is debt, but not all programs are ridiculously expensive and every person's financial situation is different. There are Counseling PhD programs that focus less on research and offer a stipedned.

I often see this stance on this forum (to simply obtain a mid-level degree), and the logic often makes sense. However, I personally did not have a clear picture of what I wanted my career to look like when I entered graduate school. I still don't. But I do know I need to reduce my caseload and I am not taking any new patients!

It's not so much PsyD vs PhD as it is professional schools vs traditional brick and mortar schools. Any legit PsyD is going to take up as much time as a PhD and will be similarly competitive, although you are right that the research component will be less emphasized. If you go the professional school route, you are looking at massive cohorts and 200,000 dollars in debt. I'd first be curious as to why a doctoral program over another degree? You can do exactly the same clinical with with a LSCW or LMFT degree (e.g. "listening to patients"), with half the time and money. I'm not saying don't get your doctorate degree, just to put in some thought if this is the best route for you at this point in your life?

 

[LadyHalcyon]

Also, psychology isn't the problem. This is a Healthcare problem and actually psychologists are somewhat "safe." Physicians and nurses have some of the highest suicide rates now; this is a more recent change due to burnout. This is a problem in pharmacy as well. How many private practice medical groups do you see these days? I love psychology and I don't regret my decision one bit. However, I was very jaded at the lack of opportunities initially and the predatory nature of this field. I was told by a member in here once, "The layer cake is real." I would never work for a large government organization, including academia. The organizations are constantly being asked to do more with less. I'm already frustrated by the fact I have to contract with them!

 

[Sanman]

I don't understand why people wouldn't encourage a person to obtain a doctorate. I work with many master's level clinicians and they are severely limited in regards to what they can do. We have many more options available to us and, in my area (more rural), we have a serious lack of providers.

I often see this stance on this forum (to simply obtain a mid-level degree), and the logic often makes sense. However, I personally did not have a clear picture of what I wanted my career to look like when I entered graduate school. I still don't. But I do know I need to reduce my caseload and I am not taking any new patients!

In this case, I would not suggest a doctorate because in most states (I won't say all as I am unfamiliar with all state laws) a Psychiatric Nurse Practitioner is already licensed to provide psychotherapy. I have NP colleagues who do this in their private practices all this time. Whether the OP feels competent to do so is a different matter. I am a proponent of not spending more time and money in a degree than you have to in order to accomplish your goals. I didn't always feel that way, but once in the real world my views have changed. In this case, the OP may opt for private practice and more years of school and educational debt do not help that cause. If there was a reason to obtain the doctorate over a lesser credential, I would be all for it.

 

[IamOat]

I don't understand why people wouldn't encourage a person to obtain a doctorate. I work with many master's level clinicians and they are severely limited in regards to what they can do. We have many more options available to us and, in my area (more rural), we have a serious lack of providers.

This is the question I'm facing right now. Why do I need a doctorate? If I was just doing therapy I can see why it wouldn't be needed but as I've worked longer in the psych field there are some things that I've seen only psychologists able to do like neurocognitive evals on our patients who have suffered strokes. I'm not sure I'll get the same level of focus and training in an MFT program if this is the population I want to work with and if I do decide that research is something for me will I be better prepared to take that on with a PsyD or PhD.

 

[IamOat]

In this case, I would not suggest a doctorate because in most states (I won't say all as I am unfamiliar with all state laws) a Psychiatric Nurse Practitioner is already licensed to provide psychotherapy. I have NP colleagues who do this in their private practices all this time. Whether the OP feels competent to do so is a different matter. I am a proponent of not spending more time and money in a degree than you have to in order to accomplish your goals. I didn't always feel that way, but once in the real world my views have changed. In this case, the OP may opt for private practice and more years of school and educational debt do not help that cause. If there was a reason to obtain the doctorate over a lesser credential, I would be all for it.

Part of this has to do with not living in an independent practice state. While there's been several pushes for independent practice I don't see it happening anytime soon. In my state NP's are mainly seen as adjuncts (which I don't terribly mind) but regardless of your experience and training exceeding that of your average physician who spent 4-6 weeks rotating through psychiatry you're still seen as this child that needs to be supervised and when something isn't to the physician's liking they want to speak to your supervising physician.

 

[IamOat]

I'm grateful for everyone's input in this thread. If I do do this (which I'm still just researching it as a possibility) I want to avoid a diploma mill or other for-profit institutions. I won't be the most competitive applicant but also not the worst. What somewhat competitive programs would you recommend for someone who's a solid B+/A- student that don't cost an arm and a leg.

 

[Sanman]

Part of this has to do with not living in an independent practice state. While there's been several pushes for independent practice I don't see it happening anytime soon. In my state NP's are mainly seen as adjuncts (which I don't terribly mind) but regardless of your experience and training exceeding that of your average physician who spent 4-6 weeks rotating through psychiatry you're still seen as this child that needs to be supervised and when something isn't to the physician's liking they want to speak to your supervising physician.

In geriatrics and outside PP, we still need physician orders to see patients and they are often a referral stream. So, having to play nice to an ego is still a thing. This may be more true with ACOs pushing for multi-disciplinary practices. The other issue is that you are likely to be talking an income drop and fewer practice options than with your current license.

Get the Insiders Guide to Clinical and Counseling Psych Programs by Norcross for doctoral level options to explore.

 

[bcliff]

The neurocognitive (or, neuropsychological) evaluations that you mentioned are, at a pretty gross level, what initially drew me to the field of clinical psychology over other mental health disciplines. I also enjoy research, so the PhD route seemed like a no-brainer for me -- I don't have any regrets about having pursued this career/training path, and I currently have a 60/40 research-clinical split, which I really enjoy.

Given your training in pharmacotherapy, I imagine that some faculty involved in research on behavioral pharmacology, neuropsychology/neuroscience, etc. might be particularly interested in having your perspective within their lab -- Are there institutions nearby with individuals (e.g., PhD, MD) doing this type of work, even if its outside the scope of traditional clinical psychology? Working in one of these labs, either as an employee or volunteer, for at least 12 months would likely be a big boost to your competitiveness for PhD programs.

I do some work in this area, so feel free to PM me if you have specific questions -- I have no idea if this is an area that you're even interested in pursuing, but I think that leaning into the uniqueness of your training background could help you increase your marketability to doctoral programs, particularly if there are some areas that may be a little light/lacking (e.g., time spent working as an RA in a lab).

 

[bcliff]

In terms of what "research" actually looks like in clinical psychology:

(1a.) I enjoy statistics but am by no means a statistician. I regularly consult with statisticians and quantitative psychologists to assist with data analysis and methodological concerns. There is no shame in this -- Nobody is expected to know everything; research is a collaborative and iterative process.
(1b.) That being said, I do need to be able to defend the techniques being used to analyze/manipulate the data that I am reporting, so I use these consultations as opportunities to enhance my own understanding of various statistical techniques -- As a rule, I don't run/report analyses that I can't defend, explain, etc.
(2.) The research questions that I'm interested in addressing are closely linked with the clinical populations I work with -- I have two projects that are currently grant funded, both of which were inspired by frustrations I encountered as a clinician.
(3.) I read a lot of empirical articles to stay current with what other people in "my" field are doing -- Reading the work of others (particularly their limitations and suggested future directions) often helps me generate new research questions, hypotheses, etc.
(4.) I am still a trainee and am also funded by other people's grants, on which I do a lot of work with recruitment and data collection, which is obviously a super important step in conducting research but one that is a little bit more on the technical side (e.g., an undergrad with adequate time and training could probably do it) -- This is something though that I will likely spend less time doing when I am no longer a trainee.
(5.) When starting a new project, I dedicate a sizable amount of time to getting institutional approval to actually conduct the research I want to conduct.
(6.) Even though I have some protected research time (i.e., a lot of my "research" time is bought by other people's grants), dissemination of findings (e.g., writing) often has to take place on nights and weekends. This is something that I'm hoping will change/improve when I am no longer a trainee.

This is by no means exhaustive but maybe gets a little bit towards your "day in the life" request. Others' experiences may vary considerably. Again, feel free to PM if you have specific questions.