Podiatry vs Psychiatry

Burrell College of Osteopathic Medicine
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it seems that podiatry has so much in common with traditional medical school yet it has a separate degree, while psychiatry seems like it could more easily placed on a separate degree track
 
married n broke said:
Why is it that Podiatry has a completely different track & degree, but Psychiatry is an MD/DO? Blows me away. Any comments?
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I am in no way going to insult podiatry. Podiatrists are part of the healthcare team, and serve a niche....obviously.

The reason why I see podiatry having no place as a MD/DO specialty is this: They have no exclusive turf. Ortho surgeons can do surgery on broken bones in the foot, ankle, leg, etc. just like some podiatrists. Sports medicine and Family Medicine doctors can handle all non-surgical foot/ankle/leg problem, and often do so.

I am not argueing that either podiatrists or ortho/fam/sports med people are better.

There are plenty of foot problems out there, and podiatry does a good job at what they do.

Psychiatry has an exclusive turf that many other doctors shy away from. Few docs want to manage psychiatric issues. Many family medicine docs won't even prescribe basic anti-depressants or anxiety meds much less try to keep track of schizophrenic patients, etc. Almost all other physicians run in fear of prescribing psychoactive drugs in children/adolescents (even psychiatrists not fellowship trained in children won't do it). Psychiatrists have a dedicated turf.
 
TexasPhysician said:
I am in no way going to insult podiatry. Podiatrists are part of the healthcare team, and serve a niche....obviously.

The reason why I see podiatry having no place as a MD/DO specialty is this: They have no exclusive turf. Ortho surgeons can do surgery on broken bones in the foot, ankle, leg, etc. just like some podiatrists. Sports medicine and Family Medicine doctors can handle all non-surgical foot/ankle/leg problem, and often do so.

I am not argueing that either podiatrists or ortho/fam/sports med people are better.

There are plenty of foot problems out there, and podiatry does a good job at what they do.

Psychiatry has an exclusive turf that many other doctors shy away from. Few docs want to manage psychiatric issues. Many family medicine docs won't even prescribe basic anti-depressants or anxiety meds much less try to keep track of schizophrenic patients, etc. Almost all other physicians run in fear of prescribing psychoactive drugs in children/adolescents (even psychiatrists not fellowship trained in children won't do it). Psychiatrists have a dedicated turf.
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It would seem to me that becoming a psychiatrist should be a Pharm.D w/ a residency as oppose to M.D. All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D. I know I haven't been through medical school yet but it just seems like a lot of unnecessary info to someone who wants to go into psychiatry. Having a psychiatrist actually know that the drug their prescribing is a SNRI or a TCA ... it happened to my sister. I asked the guy what it was and he didn't know...come now.
 
doxycycline said:
It would seem to me that becoming a psychiatrist should be a Pharm.D w/ a residency as oppose to M.D. All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D. I know I haven't been through medical school yet but it just seems like a lot of unnecessary info to someone who wants to go into psychiatry. Having a psychiatrist actually know that the drug their prescribing is a SNRI or a TCA ... it happened to my sister. I asked the guy what it was and he didn't know...come now.
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Well, a psychiatrist who doesn't know that is a complete fraud and should hardly be held as an example of the entire field. I don't think Pharm.D is a viable option because psychiatrists don't prescribe in a vacuum, you have to take in all other conditions that the pt may have plus I don't think there's any way you could do that job adequately without the kind of thorough knowledge of neurology that you begin to acquire in med school.
 
doxycycline said:
It would seem to me that becoming a psychiatrist should be a Pharm.D w/ a residency as oppose to M.D. All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D. I know I haven't been through medical school yet but it just seems like a lot of unnecessary info to someone who wants to go into psychiatry. Having a psychiatrist actually know that the drug their prescribing is a SNRI or a TCA ... it happened to my sister. I asked the guy what it was and he didn't know...come now.
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This is one of the most ridiculous and ignorant things I've ever heard. Clearly you haven't spent any time rotating through psychiatry. Most of what my preceptors/attendings did was psychotherapy, coupled with a lot of research and clinical trials (not necessarily of medications).

Re: "All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D." You know, I really hate this argument. I have a good friend who is completing her PhD in psychology who echoed this exact sentiment. This is absolutely not true and demonstrates a seriously limited scope of experience.
 
married n broke said:
Why is it that Podiatry has a completely different track & degree, but Psychiatry is an MD/DO? Blows me away. Any comments?
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you are right. they both start with P. why not clump feet and brains together?
That means derm and dentists should be able to get dermadentology degree at the same beauty school.
 
doxycycline said:
It would seem to me that becoming a psychiatrist should be a Pharm.D w/ a residency as oppose to M.D. All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D. I know I haven't been through medical school yet but it just seems like a lot of unnecessary info to someone who wants to go into psychiatry. Having a psychiatrist actually know that the drug their prescribing is a SNRI or a TCA ... it happened to my sister. I asked the guy what it was and he didn't know...come now.
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I'm with LadyWolverine - this is one of the most idiotic things I've read on SDN.

There are tons of medical conditions that present with psychiatric complications. Saying that they only prescibe antidepressants like candy is a little insulting to the entire field.

I also don't believe your little fake anecdote, either.
 
xanthomondo said:
I'm with LadyWolverine - this is one of the most idiotic things I've read on SDN.

There are tons of medical conditions that present with psychiatric complications. Saying that they only prescibe antidepressants like candy is a little insulting to the entire field.

I also don't believe your little fake anecdote, either.
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Sorry?
 
doxycycline said:
It would seem to me that becoming a psychiatrist should be a Pharm.D w/ a residency as oppose to M.D. All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D. I know I haven't been through medical school yet but it just seems like a lot of unnecessary info to someone who wants to go into psychiatry. Having a psychiatrist actually know that the drug their prescribing is a SNRI or a TCA ... it happened to my sister. I asked the guy what it was and he didn't know...come now.
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Ignorant comments.
 
doxycycline said:
Sorry?
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I don't think they buy your story about a psychiatrist not knowing the difference between a SNRI and a TCA. And on another note, why are you pimping your sister's psychiatrist? I stopped going to my sister's psych appts a long time ago...
 
doxycycline said:
It would seem to me that becoming a psychiatrist should be a Pharm.D w/ a residency as oppose to M.D. All they do is prescribe medicine really the psychotherapy is usually handled by the Ph.D/Psy.D. I know I haven't been through medical school yet but it just seems like a lot of unnecessary info to someone who wants to go into psychiatry. Having a psychiatrist actually know that the drug their prescribing is a SNRI or a TCA ... it happened to my sister. I asked the guy what it was and he didn't know...come now.
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sounds about right! 🙄
 
Dr Skeptismo said:
I don't think they buy your story about a psychiatrist not knowing the difference between a SNRI and a TCA. And on another note, why are you pimping your sister's psychiatrist? I stopped going to my sister's psych appts a long time ago...
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This was like 5 years ago and it wasn't that he didn't know the difference. He kept throwing drugs at her. She had a bad reaction to a particular SSRI so he goes into a stack of samples drug companies give him and said "here try this." So I asked if it was a TCA because I thought it was.. he said he didn't know but that patients responded well to it. I looked it up later it was a SNRI. A psychiatrist should know at least the type of drug he's giving his patients. Theres a big difference in side effects between a TCA and a SNRI. And sorry if you don't like my anecdote, I don't really care my opinion on psychiatry remains the same.
 
Board certified psychopharmacologists are the way to go. Still pretty surprising about not knowing the difference between elavil and venlafaxine though. I bet the shrink was on the older side. All docs have a responsibility to stay current on research, and I attribute his/her ineptitude on that (as well as ethics) more so than a psychiatrists training. It is a worthy and tough specialty.
 
Psychiatrists require a medical degree because sheer magnitude of overlap between it and the other medical specialties. Autoimmune, endocrine, and neuro problems may clinically manifest as psychiatric symptoms. Diabetics are more likely to have depression and vice versa. Certain psychotropic meds can have significant metabolic side effects that need to be managed by someone who fully understands the costs and benefits (both medically and psychiatrically) of staying on those medications and help the patients decide what they want to do. There are multiple studies that correlate heart disease with depression (and particularly new-onset depression in patients s/p cardiovascular surgery). And this is just the tip of the iceberg...

Making a decision about an entire medical specialty based on one interaction with someone who may have been a poor physician no matter what their specialty seems pretty immature to me. If we all did that, then let me pronounce that the entire field of cardiothoracic surgery is a joke since the CTS who did my dad's transplant refused to talk to us and only gave a "two thumbs up" after finishing the surgery and walked out of the family waiting area without uttering a single word.

We've all got "crappy doctor" stories. It reflects on the person, not the field.
 
Segovia said:
Board certified psychopharmacologists are the way to go. Still pretty surprising about not knowing the difference between elavil and venlafaxine though. I bet the shrink was on the older side. All docs have a responsibility to stay current on research, and I attribute his/her ineptitude on that (as well as ethics) more so than a psychiatrists training. It is a worthy and tough specialty.
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Yeah he was on the older side. What type of degree do psychopharmacologists have?
 
doxycycline said:
This was like 5 years ago and it wasn't that he didn't know the difference. He kept throwing drugs at her. She had a bad reaction to a particular SSRI so he goes into a stack of samples drug companies give him and said "here try this." So I asked if it was a TCA because I thought it was.. he said he didn't know but that patients responded well to it. I looked it up later it was a SNRI. A psychiatrist should know at least the type of drug he's giving his patients. Theres a big difference in side effects between a TCA and a SNRI. And sorry if you don't like my anecdote, I don't really care my opinion on psychiatry remains the same.
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Have you ever thought that the Psychiatrist actually did know what it was and just didn't want to keep answering questions from an, based on this thread, annoying, inquisitive little premed?? Also many medical conditions can present as psychiatric disorders so once you are in medical school and do your psych rotation your opinion that Psychiatrists don't need to go through medical school will probably change.
 
deuce924 said:
Have you ever thought that the Psychiatrist actually did know what it was and just didn't want to keep answering questions from an, based on this thread, annoying, inquisitive little premed?? Also many medical conditions can present as psychiatric disorders so once you are in medical school and do your psych rotation your opinion that Psychiatrists don't need to go through medical school will probably change.
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The kid's screen-name is an antibiotic and he has a stethoscope as an avatar. I think we know the type.
 
deuce924 said:
Have you ever thought that the Psychiatrist actually did know what it was and just didn't want to keep answering questions from an, based on this thread, annoying, inquisitive little premed?? Also many medical conditions can present as psychiatric disorders so once you are in medical school and do your psych rotation your opinion that Psychiatrists don't need to go through medical school will probably change.
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sideways said:
The kid's screen-name is an antibiotic and he has a stethoscope as an avatar. I think we know the type.
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:laugh:

I don't know, though. Psychiatrists are usually people so far from the bottom of the barrel of doctors that most high school students are smarter than them.
 
doxycycline said:
Yeah he was on the older side. What type of degree do psychopharmacologists have?
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You know, I was talking with insufficient knowledge on the subject. My bad. Technically, there is no such "specialty", per se in psychopharmacolgy, although their are defiinitely grad programs in this field. All MD/DO grads should possess rudimentary pyschopharm knowledge, and apparently a psychiatrist can deem themselves a psychopharm if they want to.

However, there is the American Society of Clinical Psychopharmocologists whose members must be board certified physicians and must take an advanced pyschopharm test every 5 years to remain members. I am glad you asked me this because I didn't realize this myself. I thought maybe shrinks could do further fellowship type training in this field, but from the research I have done, it doesn't look that organized. It is kind of sad, because my GP knows more about the subject than your sister's doc. New drugs are being pumped out every year, so it begs the question of whether shrinks are required to demonstrate their competency in this area, or if they just stay current on their own volition. I am really not that sure. Probably a good question for the Psychiatry forum 😳...I bet psychiatry would be a more competitive specialty if there were fellowships in psychopharm though. It just sounds cooler.
 
xanthomondo said:
Have you read any of the other posts in this thread? Or do you just not understand the concept of sarcasm?
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I've read them, but I replied to your post before I realized it was the same poster as earlier in the thread.

My mistake, I blame renal physiology for scrambling my brain.

In other news, I agree with you 😛
 
pingouin said:
Psychiatrists require a medical degree because sheer magnitude of overlap between it and the other medical specialties. Autoimmune, endocrine, and neuro problems may clinically manifest as psychiatric symptoms. Diabetics are more likely to have depression and vice versa. Certain psychotropic meds can have significant metabolic side effects that need to be managed by someone who fully understands the costs and benefits (both medically and psychiatrically) of staying on those medications and help the patients decide what they want to do. There are multiple studies that correlate heart disease with depression (and particularly new-onset depression in patients s/p cardiovascular surgery). And this is just the tip of the iceberg...

Making a decision about an entire medical specialty based on one interaction with someone who may have been a poor physician no matter what their specialty seems pretty immature to me. If we all did that, then let me pronounce that the entire field of cardiothoracic surgery is a joke since the CTS who did my dad's transplant refused to talk to us and only gave a "two thumbs up" after finishing the surgery and walked out of the family waiting area without uttering a single word.

We've all got "crappy doctor" stories. It reflects on the person, not the field.
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Agreed. Every field of medicine has its fair share of "lacking" physicians. What you see in medical school is sometimes shocking. You can't insult a profession because of 1 doctor.

For those that don't understand why psychiatry is a medical specialty, wait until you actually go through it in MSIII. Psychiatrists prescribe psychotropic drugs that interact with many other drugs and have many side-effects, they treat addiction, they treat sleep problems, and they often even treat neuro conditions. There is LOTS of overlap between psychiatry and neurology.
 
thank you for this thread. the title made me lol. i agree with OP. podiatry is more medicine than psychiatry is. people will get ticked off and argue, but it's true. you can memorize a list of meds, know how to work a dsm-iv, and have basic communication skills and you will be in the top half of psychiatrists. and maybe they can interpret a thyroid panel. i've been thinking about making up psychiatric conditions so that when someone is identified with it, they could name it after me. bydotte psychosis - fear of extra-crunchy peanut butter. no, believe it or not, i'm not board-certified, but i did get an honors in my psych clerkship. as if you needed any more evidence of what a bunch of crap it is.
 
yeah i can go around dissing plumbers all day....until my toilet starts backing up and there's crap all over my bathroom floor. Then plumbers quickly become the most important people on earth.
 
Segovia said:
Board certified psychopharmacologists are the way to go. Still pretty surprising about not knowing the difference between elavil and venlafaxine though. I bet the shrink was on the older side. All docs have a responsibility to stay current on research, and I attribute his/her ineptitude on that (as well as ethics) more so than a psychiatrists training. It is a worthy and tough specialty.
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Yea .. I m waiting for some genius out there to come up with the idea of Pharm-Practioner type of deal... hell if nurses can become practioners, pharmacists are well beyond capable.
 
NRAI2001 said:
Yea .. I m waiting for some genius out there to come up with the idea of Pharm-Practioner type of deal... hell if nurses can become practioners, pharmacists are well beyond capable.
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it exists. there are threads on this forum about it.
 
bydotte said:
thank you for this thread. the title made me lol. i agree with OP. podiatry is more medicine than psychiatry is. people will get ticked off and argue, but it's true. you can memorize a list of meds, know how to work a dsm-iv, and have basic communication skills and you will be in the top half of psychiatrists. and maybe they can interpret a thyroid panel. i've been thinking about making up psychiatric conditions so that when someone is identified with it, they could name it after me. bydotte psychosis - fear of extra-crunchy peanut butter. no, believe it or not, i'm not board-certified, but i did get an honors in my psych clerkship. as if you needed any more evidence of what a bunch of crap it is.
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Because honoring a 6 week intro to the field makes you an expert.... 👎laugh:
 
bydotte said:
thank you for this thread. the title made me lol. i agree with OP. podiatry is more medicine than psychiatry is. people will get ticked off and argue, but it's true. you can memorize a list of meds, know how to work a dsm-iv, and have basic communication skills and you will be in the top half of psychiatrists. and maybe they can interpret a thyroid panel. i've been thinking about making up psychiatric conditions so that when someone is identified with it, they could name it after me. bydotte psychosis - fear of extra-crunchy peanut butter. no, believe it or not, i'm not board-certified, but i did get an honors in my psych clerkship. as if you needed any more evidence of what a bunch of crap it is.
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double post
 
TexasPhysician said:
Because honoring a 6 week intro to the field makes you an expert.... 👎laugh:
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not at all. i'm not an expert in anything, let alone anything medical. i was just trying to be inflammatory. i surrender. seriously though, watching a podiatrist doing surgery, then watching a psychiatrist stammering through group therapy... worlds apart
 
bydotte said:
not at all. i'm not an expert in anything, let alone anything medical. i was just trying to be inflammatory. i surrender. seriously though, watching a podiatrist doing surgery, then watching a psychiatrist stammering through group therapy... worlds apart
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The amount of ignorance in this thread is astounding, and frightful.
 
bydotte said:
it exists. there are threads on this forum about it.
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I ve heard of clinical pharmacists.. they can work in a hospital and from what I understand they basically work with doctors to optimize complicated drug regimens (which I could imagine could be very beneficial to patients)? BUT they can not work independently or in their own private clinics like nurse practioners do..
 
doxycycline said:
So I asked if it was a TCA because I thought it was.. he said he didn't know but that patients responded well to it. I looked it up later it was a SNRI. A psychiatrist should know at least the type of drug he's giving his patients. Theres a big difference in side effects between a TCA and a SNRI. And sorry if you don't like my anecdote, I don't really care my opinion on psychiatry remains the same.
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I'm not sure if you are aware (or if it was mentioned earlier) but for many medications (esp. psych drugs) no one "knows" how they work exactly, esp drugs that only make symptoms bearable as opposed to curing a disease). A group of chemicals is tried for a chronic condition that will make a pharm company a lot of money, the one that works best is continues until the side effects get too bad to ignore (or until it gets to market and people start dying). The human brain is so complex it is impossible to tell exactly how these chemicals will affect your entire brain. The same thing goes for many other drugs which is why so many studies find that all those drugs decreasing symptoms of a chronic disease don't necessarily improve the health outcomes and why they have found that Anti-Ds really only work for severly depressed patients.

So much of what doctors perscribe is pushed by pharm companies not patient need (thus how 50% of the most profitable industry in the world was made in a country that hasn't gotten any healthier, esp. mentally). I attend a college doing research on DBS treatment for depression that is the most ridiculously biased thing I have ever read, and (like happens so often) the researchers were "associates" of a DBS production company.
 
Perrotfish said:
Best thing you've ever posted.
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touche.

however i'm really not that type, its a pre-med/med forum and i picked a user name and avatar. i don't get the big deal, i'm a member of a car forum as well and my username and avatar are related to different cars i like. OMG, you must be on to something here!:idea:

and as far as this thing goes, i don't care. i don't have to like/care for psychology or psychiatry. believe me this wasn't my only encounter with these doctors. overall i don't like the drug pushing as a previous poster stated and OK i'm a little naive with the whole MD or PharmD thing - it wasnt a statement based on really any factual knowledge. Sue me, its the internet. Sorry to offend all you aspiring psychiatrists.
 
doxycycline said:
touche.

and as far as this thing goes, i don't care. i don't have to like/care for psychology or psychiatry. believe me this wasn't my only encounter with these doctors. overall i don't like the drug pushing as a previous poster stated and OK i'm a little naive with the whole MD or PharmD thing - it wasnt a statement based on really any factual knowledge. Sue me, its the internet. Sorry to offend all you aspiring psychiatrists.
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Really as a future physician that is your position. A little scary and I hope you become more open-minded once in med school. I wasn't interested in belittling you just informing you. Btw maybe you should rethink dismissing entire groups of people without the facts. If you want to make ridiculous statements based on nothing then be open to correction. And an apology doesn't seems sincere when you preface it with the fact that you don't care.

Edit: didn't realize you were already a med student...I just hope your aversion to psych doesn't impair the effectiveness of your future treatment/diagnosis of patients. Though if I decided today that radiology wasn't worth my time I can't image how it wouldn't affect mine.
 
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my buddy in pod school always stresses that he's in MED school.... not pod school. i think it's pretty funny. he took the mcat thrice and didnt do that hot so he went the pod route instead of med. i use to get annoyed but im too knee deep in med school'ness to even care.

once youre in med school, you quickly realize how little you know.... and how little your colleagues 'know' as well
 
Thank you to the several of you who rose to the defense of psychiatry. The truth is, that psych really does grab from the bottom of the barrel a lot of the time. Board scores follow money. This does lead to a lot of unfortunate encounters with practitioners who don't know what the hell they are doing and leave a sour taste in everyones' mouth. Doesn't change the fact that psych is a medical specialty for a reason.

Just a couple of examples of why medical training is important:

1. Had a patient with bad anxiety. And rather difficult to control HTN. I didn't need to consult medicine to handle her HTN, because I am a doctor. I was also able to pick up on the fact that a lot of her anxiety symptoms were somatic in nature (sympathetically-mediated issues such as trembling, easy startle, and tachycardia/chest pounding. I decided to try to kill two birds with one stone and picked an alpha and beta blocking drug that crossed the BBB. Labetalol. Worked freakishly well. If I wasn't a physician, I wouldn't have been able to come up with something like that.,

2. A patient with numerous physical complaints including stroke, seizure, lupus, visual hallucinations, and a couple of others. It became rapidly obvious that there was a significant component of somatization there. Of course, to make a diagnosis of somatization you have to rule out medical causes. Even though she'd been put through the ringer of diagnostic tests, all of which were negative or inconclusive, none of the specialists involved in her care were willing to say she was somatizing. In the end, I had to put my foot down and argue my case from a medical as well as a psychiatric standpoint. Wouldn't have been very effective at that if I hadn't gone to med school.

More importantly, doxy, I hope you either learn to gain an appreciation for psychology and mental health, or you go into path or radiology. Seriously. Medical problems cause psychiatric issues. Mental health influences the experience of physical complaints. And then there's the whole aspect of conscious versus subconscious secondary gain. The ability to identify how the mental aspect complicates the medical picture is the difference between overtreatment, undertreatment, and the success of the patient.
 
masterofmonkeys said:
1. Had a patient with bad anxiety. And rather difficult to control HTN. I didn't need to consult medicine to handle her HTN, because I am a doctor. I was also able to pick up on the fact that a lot of her anxiety symptoms were somatic in nature (sympathetically-mediated issues such as trembling, easy startle, and tachycardia/chest pounding. I decided to try to kill two birds with one stone and picked an alpha and beta blocking drug that crossed the BBB. Labetalol. Worked freakishly well. If I wasn't a physician, I wouldn't have been able to come up with something like that.,
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Pheo?

Good post. I used the knowledge from my psych rotation frequently on other rotations, especially in the ambulatory setting. I have no desire to go into it, but I'm not naive enough to dismiss the entire field.
 
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