Recently, I've begun to vacillate between pursuing a PhD in clinical psychology and going to medical school to become a psychiatrist. I've essentially dedicated the past 4 years to the PhD route: completing pre-reqs, research experience, clinical experience, strong GRE's, etc. Now, with a couple months remaining before applications are due, I've been thinking of the alternative MD. For one, it seems as though the demand for psychiatrists is greater and will continue to increase, whereas I've heard that the clinical psychologist may wither into obscurity. The prescription priviledges of the psychiatrist is a huge plus. Additionally, the comparison in pay between the two professions is....well...no comparison. I don't want to sound greedy, but I expect 6 or 7 years of further education to pay off, and I (like the rest of you) want to live comfortably. One of the problems with the MD, however, is that I haven't taken the necessary chem, physics, anatomy classes nor the MCAT. And the truth is, I don't think I would be very strong or competitive in these courses. I would have to be sure that medical school is what I want before I completely change my focus. Is anyone else feeling this way? I know that some of this indecision must be a product of my anxiety about applying to grad school, but I just can't help thinking about the alternative. I've also heard that some individuals first obtain their PhD in clinical psychology and later obtain their MD. Is this a decent idea or a legitimate route to take? Any general thoughts, advice, suggestions is appreciated!
PhD or MD
- Thread starter McClinas
- Start date
Unless you had a great interest in other areas of medicine other than psychiatry, I would highly advise against going through the MD route. Before you can even begin your psychiatry residency, you have to complete a preliminary year (internship year) doing internal medicine. That's a lot of on call nights and long hours. Which is great if psychiatry is definitely what you want to do, but it is a very different approach to mental health than a clinical psychologist. Just my $.02
- Joined
- Sep 23, 2009
- Messages
- 189
- Reaction score
- 1
I had that same dilemma a few years ago. As far as the pay differential goes, my uncle (an MD) put it this way: when you get your PhD, you are given free tuition, and a stipend (albeit, not a significant one). But when you get your MD, you have to pay for tuition on your own (usually with loans), plus you receive no stipend. As an intern, etc you make very little (I think around 30 grand a year) and then eventually you start making the big bucks--but you're still paying a significant portion of your salary towards your student loans. Plus, if you're in private practice you're paying astronomical malpractice insurance fees, etc. So basically, the difference in pay is not as dramatic as it seems, and it takes a long time for an MD to be making more in a PhD, everything considered.
- Joined
- Nov 25, 2005
- Messages
- 331
- Reaction score
- 1
Just to clarify some misinformation:
Psychiatry residents make 40-50K per year typically, which increases every year of residency. Yes, this isn't that much, but remember that a lot of licensed clinical psychologist make that much full-time to start with. Thus, though you're in school longer for the MD route, and it costs more (assuming you're comparing it to a fully-funded PhD), there is no comparison monetarily. Even playing catchup for a few years of extra training and paying off loans, most psychiatrists will make 3x what psychologists make, so one overtakes the handicap in a few years. Also, malpractice for psychiatrists (unlike other medical professions) is not that astronomical. Considering how much you can make as a psychiatrist in practice (150-200K starting), it pales in comparison.
Also, don't let a bunch of pre-med courses dictate what you do or don't do with your career. You'll be working for 30+ years, if you have to go back and take a year of courses, it won't be much in the long-term. However, you should be a relatively good student of the sciences, and get a 3.5+ average in your pre-med courses if you want a legit shot.
All that being said, I'm not saying that psychiatry is the way to go. You can't put a price on your life satisfaction and personal values when it comes to the type of treatment you want to provide. Medicine is a wonderful career, but its long and hard, and psychiatrists have pretty much become pharmacotherapists nowadays thanks to managed care. Some people people don't mind this (nor should they), but its also not for a lot of people. Psychology has its pros and cons too, but the best thing you can do is to talk to practitioners in both fields and reflect on whats important to you.
Psychiatry residents make 40-50K per year typically, which increases every year of residency. Yes, this isn't that much, but remember that a lot of licensed clinical psychologist make that much full-time to start with. Thus, though you're in school longer for the MD route, and it costs more (assuming you're comparing it to a fully-funded PhD), there is no comparison monetarily. Even playing catchup for a few years of extra training and paying off loans, most psychiatrists will make 3x what psychologists make, so one overtakes the handicap in a few years. Also, malpractice for psychiatrists (unlike other medical professions) is not that astronomical. Considering how much you can make as a psychiatrist in practice (150-200K starting), it pales in comparison.
Also, don't let a bunch of pre-med courses dictate what you do or don't do with your career. You'll be working for 30+ years, if you have to go back and take a year of courses, it won't be much in the long-term. However, you should be a relatively good student of the sciences, and get a 3.5+ average in your pre-med courses if you want a legit shot.
All that being said, I'm not saying that psychiatry is the way to go. You can't put a price on your life satisfaction and personal values when it comes to the type of treatment you want to provide. Medicine is a wonderful career, but its long and hard, and psychiatrists have pretty much become pharmacotherapists nowadays thanks to managed care. Some people people don't mind this (nor should they), but its also not for a lot of people. Psychology has its pros and cons too, but the best thing you can do is to talk to practitioners in both fields and reflect on whats important to you.
In making your decision whether to pursue psychiatry or psychology, ask yourself how MUCH you want to know about mental illness and how interested you are in really understanding the theory behind psychopathology.
While in graduate school and on internship at a medical school, one thing that struck me about psychiatry residents is that all they really know about mental illness is what drugs to throw at the symptoms the person is complaining about. By and large, they do not learn about the psychological and psychosocial causes/etiology of mental illness (e.g., that borderline personality disorder is thought to be caused by an invalidating childhood, etc), detailed assessment (e.g., how to spot anxiety-related interference on an IQ test to help tease out major depression vs. anxiety vs. thought disorder, etc.), how to do in-depth therapy focused on abating the root causes of the disorder, etc.
When encountering a person with major depressive disorder, a really well-trained psychologist would ask: what schemas were formed in the person's past that are causing his/her distorted depressogenic thinking?, what underlying assumptions does this person hold that maintain his/her depressogenic thinking?, does this person have an underlying personality disorder that is maintaining this disorder?, if so, which one(s)?, what strengths does this person have that can be capitalized on to help ameliorate their psychological dysfunction?. A mid level provider, such as a psychiatrist, would typically say to himself/herself, "this person can't sleep, let me give them a sleeping pill and to help with the person's sad mood let me give them an antidepressant that won't exaccerbate their high blood pressure. Now let me see my next patient for 5 minutes."
While in graduate school and on internship at a medical school, one thing that struck me about psychiatry residents is that all they really know about mental illness is what drugs to throw at the symptoms the person is complaining about. By and large, they do not learn about the psychological and psychosocial causes/etiology of mental illness (e.g., that borderline personality disorder is thought to be caused by an invalidating childhood, etc), detailed assessment (e.g., how to spot anxiety-related interference on an IQ test to help tease out major depression vs. anxiety vs. thought disorder, etc.), how to do in-depth therapy focused on abating the root causes of the disorder, etc.
When encountering a person with major depressive disorder, a really well-trained psychologist would ask: what schemas were formed in the person's past that are causing his/her distorted depressogenic thinking?, what underlying assumptions does this person hold that maintain his/her depressogenic thinking?, does this person have an underlying personality disorder that is maintaining this disorder?, if so, which one(s)?, what strengths does this person have that can be capitalized on to help ameliorate their psychological dysfunction?. A mid level provider, such as a psychiatrist, would typically say to himself/herself, "this person can't sleep, let me give them a sleeping pill and to help with the person's sad mood let me give them an antidepressant that won't exaccerbate their high blood pressure. Now let me see my next patient for 5 minutes."
- Joined
- Jan 13, 2009
- Messages
- 534
- Reaction score
- 460
You will be hard-pressed to find better training in mental health than through a clinical psychology doctoral program. Psychologists are trained in the most comprehensive and robust model of human behavior (both "normal" and abnormal) and mental illness of all the mental health professionals. Currently, the biological aspects of mental illness dominate the mental health field, and, consequently, psychologists must remain abreast of these developments as they are essentially impossible to ignore in practice. In my experience though, I have found that psychologists have a considerably better grasp of the biological aspects of mental illness than psychiatrists typically have of the psycho-social aspects, as their role (and training) is so focused on diagnoses and treatment which largely equates to the prescription and management of medication and possible sequelae.
However, a clinical psychologist's level of training and knowledge is not necessarily rewarded in the system, and you will have many, many more doors open to you as a psychiatrist than as a psychologist in any salaried, employer-based type of setting. Salaries for psychologists are notoriously low, but this is largely the result of psychologists' inability to prescribe and manage meds; the demand in the market is clearly for pharmacotherapy.
Nonetheless, all of the psychologists I know in my area who are in private practice are clearing six figures and many are at $150,000 or more annually. You can make decent money as a psychologist, but it is almost exclusively limited to the private practice setting - salaries for psychologists are a joke. This is a HUGE difference between psychology and psychiatry. You can make a very good living as a psychiatrist in almost any salaried position, private practice is even better. The philosophical and training differences between the two are important to consider, but so are the realities of the market and the employment outlook.
That being said, if you are looking for the most bang-for-your-buck, best return-on-investment, you cannot beat advanced practice psychiatric nursing. You can make a very good living as a psych NP, and if you are in an independent practice state for NPs, the earning potential is tremendous. For example, psych NPs in my state can do everything a psychiatrist can do except for evaluations for involuntary commitment. Starting salaries are around $125,000 (in settings that don't even employ psychologists around here, i.e. CMHCs), and I know several who are clearing $200,000. Not bad for a Master's degree.
However, a clinical psychologist's level of training and knowledge is not necessarily rewarded in the system, and you will have many, many more doors open to you as a psychiatrist than as a psychologist in any salaried, employer-based type of setting. Salaries for psychologists are notoriously low, but this is largely the result of psychologists' inability to prescribe and manage meds; the demand in the market is clearly for pharmacotherapy.
Nonetheless, all of the psychologists I know in my area who are in private practice are clearing six figures and many are at $150,000 or more annually. You can make decent money as a psychologist, but it is almost exclusively limited to the private practice setting - salaries for psychologists are a joke. This is a HUGE difference between psychology and psychiatry. You can make a very good living as a psychiatrist in almost any salaried position, private practice is even better. The philosophical and training differences between the two are important to consider, but so are the realities of the market and the employment outlook.
That being said, if you are looking for the most bang-for-your-buck, best return-on-investment, you cannot beat advanced practice psychiatric nursing. You can make a very good living as a psych NP, and if you are in an independent practice state for NPs, the earning potential is tremendous. For example, psych NPs in my state can do everything a psychiatrist can do except for evaluations for involuntary commitment. Starting salaries are around $125,000 (in settings that don't even employ psychologists around here, i.e. CMHCs), and I know several who are clearing $200,000. Not bad for a Master's degree.
- Joined
- Sep 30, 2009
- Messages
- 69
- Reaction score
- 0
I'm in almost exactly the same spot as you, except that I have all my premed courses. Like you, I haven't written the MCAT. To me the prospect of going to grad school is now more daunting then ever because I know that once I'm in it's a long haul. It's sort of hard to back out once you've gone so far and taken one of those coveted spots in a clinical program. I don't want to look back and go, oh crap, I should have gone to med school. It seems that it might be impossible to really know what is best.
If anyone else could offer more helpful insights, myself (and I'm sure the OP) would greatly appreciate it. 🙂
If anyone else could offer more helpful insights, myself (and I'm sure the OP) would greatly appreciate it. 🙂
- Joined
- Sep 30, 2009
- Messages
- 69
- Reaction score
- 0
I'm in almost exactly the same spot as you, except that I have all my premed courses. Like you, I haven't written the MCAT. To me the prospect of going to grad school is now more daunting then ever because I know that once I'm in it's a long haul. It's sort of hard to back out once you've gone so far and taken one of those coveted spots in a clinical program. I don't want to look back and go, oh crap, I should have gone to med school. It seems that it might be impossible to really know what is best.
If anyone else could offer more helpful insights, myself (and I'm sure the OP) would greatly appreciate it. 🙂
If anyone else could offer more helpful insights, myself (and I'm sure the OP) would greatly appreciate it. 🙂
- Joined
- Jan 14, 2009
- Messages
- 55
- Reaction score
- 1
do an MD/Ph.D! if you're a glutton for punishment, that is...
the good news is that I think a lot of them have at least some funding
the good news is that I think a lot of them have at least some funding
- Joined
- Mar 17, 2009
- Messages
- 647
- Reaction score
- 3
I'm a former MD/PhD hopeful. I changed my mind because I just liked the idea of psychology and psychology research. I wasn't going for psychiatry before, I was going for oncology, but I found my way into a health psych research lab and fell in love.
The pre reqs for medical schools are no joke. I received the first B of my life in organic chemistry, and many of my classmates did far worse than I did. Med schools are also looking for more than just good grades and test scores; you'll have to get some shadowing experience, clinical work in hospitals... the whole 9 yards.
I say if you're going to switch, make sure it's what you want to do. Do some research (this board is a good start!) and get some experience. It's very difficult, but it's not impossible to get into med school. Personally, I found the pre-psych route the right one for me. Good luck with your decision.
The pre reqs for medical schools are no joke. I received the first B of my life in organic chemistry, and many of my classmates did far worse than I did. Med schools are also looking for more than just good grades and test scores; you'll have to get some shadowing experience, clinical work in hospitals... the whole 9 yards.
I say if you're going to switch, make sure it's what you want to do. Do some research (this board is a good start!) and get some experience. It's very difficult, but it's not impossible to get into med school. Personally, I found the pre-psych route the right one for me. Good luck with your decision.
- Joined
- Jan 22, 2009
- Messages
- 289
- Reaction score
- 2
I would try to shadow a psychiatrist before you make such a rash decision. I was contemplating MD vs PhD until I shadowed a psychiatrist and a neuropsychologist this summer. I hated what the psychiatrist did and loved what the neuropsychologist did. That made the decision much easier 🙂
- Joined
- Aug 19, 2009
- Messages
- 841
- Reaction score
- 113
I have also been interested in pursuing psychiatry because most of the time when I find a paper concerning my research interest that excites me, it seems to come out of a psychiatry group at a med school. The lab I volunteer at now is in the psychiatry dept of a major research hospital and one of our current projects directly reflects my interests.
I know psychologists are often on faculty in psychiatry depts but I hope not being an MD doesn't hold me back from being involved in the research I love. Our current project compares people on meds to baseline (among other factors) and not being able to prescribe could be a handicap.
I actually love most science classes and do very well with them but I have been out of school for some time so I would need to retake most of them. and I'm 34 so I don't really want to delay any longer.
My brother went thru med school and residency and he thinks I wouldn't like it much. I'm interested in other areas of medicine but I would find it frustrating to spend so little time on my primary interest, which is depression. I'm also a tiny bit squeamish about bodily fluids😉
so I am going to pursue the Phd.
I know psychologists are often on faculty in psychiatry depts but I hope not being an MD doesn't hold me back from being involved in the research I love. Our current project compares people on meds to baseline (among other factors) and not being able to prescribe could be a handicap.
I actually love most science classes and do very well with them but I have been out of school for some time so I would need to retake most of them. and I'm 34 so I don't really want to delay any longer.
My brother went thru med school and residency and he thinks I wouldn't like it much. I'm interested in other areas of medicine but I would find it frustrating to spend so little time on my primary interest, which is depression. I'm also a tiny bit squeamish about bodily fluids😉
so I am going to pursue the Phd.
- Joined
- Mar 28, 2007
- Messages
- 1,810
- Reaction score
- 9
If your goal is clinical work incorporating meds, get an MD. It's infinitely easier to pursue additional therapy training as a psychiatrist than it is to get prescription rights as a psychologist. If I were interested mostly in therapy, this decision would take 5 seconds.
Don't go into Med for the money, but don't shy away from Med just because some of the courses are hard. Grad school in psych is a lot of work too, if you want good training. Disliking hospital stuff is also not a good reason to avoid Med--anything that pays in clinical applied psych (e.g. forensics, hospital work, military stuff) also involves non-pretty situations.
