FWIW, in my experience I find it very rewarding to work as part of an interdisciplinary team (e.g. behavioral medicine, geriatrics, serious mental illness, or inpatient psych settings) in terms of “having all the tools to help my patients.” I need to know a good amount about medicine and psychopharmacology to function effectively in those settings, which is fun for me. But I defer to the people who had specialized training in medication management, while they defer to psychology when it comes to therapy/psych assessment/other psychological considerations. SW brings expertise in case management and coordinating resources, other professionals (AuD, SLP, OT, PT, pharmD, respiratory therapist, internal med MD, dietitian, etc.) have expertise in their area of training... No way I’d be able to provide a patient that level of care alone, even with extra certifications and trainings.
There’s also a lot of isolation and pressure in being the only treating clinician, without being able to have colleagues who see different perspectives on the patient so we can bounce ideas off each other and discuss at case conference.
I wouldn’t want to be a prescribing psychologist for that reason, even if I could (and I love learning about psychopharmacology). Further, most of our patients won’t JUST be taking psych meds - depending on the population, patients are commonly on a ton of meds for their other medical conditions that need to be considered in prescribing. For example, some psych meds can cause long QTc, lower seizure threshold, or cause hyper/hypotension or delirium in conjunction with other meds or medical conditions. Responsible prescribing gets complicated pretty quickly especially for medically complex patients. Conversely, low-risk, uncomplicated prescribing of the type that prescribing psychologists would be better suited for - e.g. initial SSRI trial in an otherwise healthy adult - can generally be handled by their PCP (though I do see a lot of folks limping along on a tiny subtherapeutic dose of an antidepressant on that side...)
Similarly, some psychiatric residencies seem to have good training in therapy but it varies a ton (there was a previous thread on this...) A psychologist will generally have much more experience - higher numbers of f2f therapy/assessment hours, cases, and supervision - in it than a psychiatrist.
so yeah tl;dr - I feel like I can best serve my patients by not thinking I’m the only person who can. If prescribing privileges are most important to you, go with Psychiatry. If providing high quality therapy and/or assessment are most important to you, go with Psychology.
