Prescribing Meds in Psych

[504196]

Hey everyone, I've got another question about psych. What appeals to me about psych is neuroscience, psychology, advances in understanding minfulness meditation as a way to improve peoples lives, and getting to know someone's deep, personal background. I just don't get excited about prescribing medications to people. Yes, I know some people NEED to be on medications d/t their severe mental illness (bipolar, schizophrenia, ect.). But for some ppl with depression and anxiety I don't get excited about putting them on meds. Or just "tweaking" some of the meds they are on. I feel that a large part of psych is medications management. But I've heard stories of psychiatrists that just do a lot of therapy and don't prescribed meds.

I guess my question is should I be turned away from psych if I feel this way?

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[nitemagi]

You don't have to be turned away, but you do have to expect to learn to do primary medication management for quite a while before you'll get to a place where you can do primary therapy only. It might not even be until after residency. I do both, and have a healthy group of patients who I only do therapy with. What's nice is that I can offer both, and understand both, so that at any point in our journey they want to explore the other, we can. IMO it makes your a better physician and psychiatrist to be able to do both.

But also be aware that not every job will give you room to do only therapy. In fact, private practice may be the only path to that, with a few rare exceptions.

 

[Attending1985]

You should be turned away

 

[TexasPhysician]

If prescribing medications is of no interest, you may want to explore clinical psychology doctorate programs. That would get you to the aspect of treatment that you enjoy faster.

 

[LadyHalcyon]

If prescribing medications is of no interest, you may want to explore clinical psychology doctorate programs. That would get you to the aspect of treatment that you enjoy faster.

Ehhhh... Not THAT much faster (probably looking at 7 years)

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[TexasPhysician]

Ehhhh... Not THAT much faster (probably looking at 7 years)

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Ive seen them done in 4 years post bachelors. That’s 1/2 time.

 

[LadyHalcyon]

Ive seen them done in 4 years post bachelors. That’s 1/2 time.

That's rare. Plus you aren't counting internship and postdoc

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[WisNeuro]

Ive seen them done in 4 years post bachelors. That’s 1/2 time.

These are diploma mills. Any reputable program is going to be 4-5 years, 1 year clinical internship, probably 1 year postdoc to accrue supervised hours for licensure in most states. If they only want to do therapy, they can always go the SW/midlevel route.

 

[erg923]

Ive seen them done in 4 years post bachelors. That’s 1/2 time.

I dont think so. The doctorate isnt awarded until after the internship year. 3 years is really not possible. The modal time for A ph.d is still 6 years. And then that doesn't count post-doc, so 7 years most of the time.

 

[dl2dp2]

You should be turned away

I second this. People who get referred to a psychiatrist in the community these days are typically VERY ILL. Only a very small number of psychiatrists can sustain a practice on mostly "worried well" patients who don't need meds--or even patients who only need one med that can be prescribed by a PMD--and typically when psychiatrists do therapy it's a specific and specialized therapy that they got very specialized training for (i.e. psychoanalysis/TFP etc). The vastly more common scenario is people are on MULTIPLE meds and you have to manage complex side effects, co-morbid substance abuse, medical co-morbidities etc etc. especially if you practice in any kind of a managed care setting.

In the last ten twenty years psychiatry has gotten much much more medicalized. I'd say the difference between a general community psychiatrist and a specialist physician in any cognitive specialty (i.e. endocrine, rheum, etc) is fairly minimal. And this is trend that will IMHO continue, since the breakthroughs (i.e. things in the future you can charge a lot of money for) in the field are almost exclusively in the medication/somatic treatment area (ketamine, TMS/devices, etc).

If you want to do pure therapy I'd do PhD/LCSW. Now that said, if you are a medical student as said on your profile, then psychiatry is certainly the specialty that would allow you to do the most psychotherapy, have longer visits, and do some psychotherapy, especially if you subspecialize, compared to any other medical specialty. Medicine itself has just gotten much more of a pushing meat every 15 min kind of a job. Doctor-patient relationship in general is de-emphasized for a lot of reasons.

 

[smalltownpsych]

The field could definitely use more psychiatrists that don't solely focus on medications. That being said, you would have to fight against the pressures to do just that. What I have seen is that the weaker and less well compensated psychiatrists focus on medications alone and the more successful, higher paid psychiatrists integrate psychology much more into their case formulations and treatment plans. As I have said on this board many times, even if they are not the person providing the psychotherapy for any specific case, they need to know what the game is and how it's being played otherwise they end up just getting in the way and being relegated to the sidelines.

 

[SeniorWrangler]

Patients will be very happy in my experience if you have things to offer them besides just medication management, but if you aren't willing to first learn and then practice psychopharmacology, you shouldn't become a psychiatrist. It's like being a carpenter who doesn't like using power tools.

 

[NontradCA]

If you’re a med student I’d just ask that you have more of an open mind regarding psychiatric drugs, regardless of whether you go into psychiatry or not. I’d challenge you to look up the effect sizes of BP drugs and compare them to SSRIs. Psychiatric medications get a bad rap, and some of it is bs, but some of it is because the field is so open about its inadequacies. Not to mention a dark past. You don’t really see people give pause when prescribed naproxen or Lipitor. Think about it.

That being said, medications work wonders and I’ve found psych patients to be more compliant, or at least, having more insight to their symptoms related to non-compliance than other fields. Hopefully that stays true through residency.