Pros/Cons of MD and PhD Clin Psych

[ohlala]

I just don't understand what are the differences between the two. You can practice with both of them. What are the pros/cons of each? Why did you choose one over the other? Thanks.

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[EL CAPeeeTAN]

I just don't understand what are the differences between the two. You can practice with both of them. What are the pros/cons of each? Why did you choose one over the other? Thanks.

Some of this you probably already know. An MD requires one to go to 4 years of medical school after which a 3 - 4 year residency (for psychiatry). A PhD in clinical psychology usually takes about 5 years of school followed by 1 year internship and often followed by a 1 - 2 year fellowship (not required) Most PhD programs are funded while medical school usually requires several thousand $$$ for tuition. Upon finishing the degrees the practice of psychiatry and clinical psychology can be quite different. For the most part a psychiatrist will make significantly more money than a psychologist. (Of course I am talking averages, there are always exceptions to the rules) For example, my brother finished his PhD in clinical psych and started a job at about 60k / year with some private practice on the side and other side psychology jobs he will make an additional 15K bringing his total to 75K while another friend of mine just finished his residency on psychiatry and took his first job at 139k / year.

Psychologists continue to practice therapy and have several years of training in therapy. Psychiatrists really do not receive much training in therapy and their practice includes medication management, hospitalizations, etc. Also psychiatrists receive more training in medical mental health, like organic based disorders etc. Psychologists in most states can't prescribe medication (although this is changing). Psychologists also perform many different mental tests / assessments. Both fields serve various needed services in mental healthcare. There often can be some resentment between the professions. For the most part they are completely different in their practices. With all of this you have to remember that these are generalizations and there are plenty of exceptions to these generalizations. Also in light of being brief I have left out many specifics but this is the general idea.

 

[LM02]

The previous poster did a nice job summarizing the general differences between the two disciplines. Though I thought I might add an important point - a PhD in clinical psychology is a research-based degree. That is, most graduate programs emphasize research and clinical science, and you will spend a significant amount of time in graduate school training in research methods, taking advanced statistics courses, and conducting your own research. Although there are some PhD programs that provide more of a balance between "clinical" and "research," even those programs will require a research-based dissertation.

So if you don't like research, a PhD in clinical psychology is not going to be a good match for you. You can certainly do research as an MD (in fact I work with psychiatrist researchers), but it is not a requirement.

Good luck in your decision!

 

[Rolandicfissure]

The previous poster did a nice job summarizing the general differences between the two disciplines. Though I thought I might add an important point - a PhD in clinical psychology is a research-based degree. That is, most graduate programs emphasize research and clinical science, and you will spend a significant amount of time in graduate school training in research methods, taking advanced statistics courses, and conducting your own research. Although there are some PhD programs that provide more of a balance between "clinical" and "research," even those programs will require a research-based dissertation.

So if you don't like research, a PhD in clinical psychology is not going to be a good match for you. You can certainly do research as an MD (in fact I work with psychiatrist researchers), but it is not a requirement.

Good luck in your decision!

A very good point. My medical school required one basic statistics course.

Obvious but still worth mentioning is that you will spend most of an MD degree learning things unrelated to Psychiatry or mental health. If hard science (biochem, anatomy, etc.) doesn't appeal to you at all, you may find it difficult to maintain interest, especially in the preclinical years.

 

[PublicHealth]

You can certainly do research as an MD (in fact I work with psychiatrist researchers), but it is not a requirement.

Are you a medical student? How early in medical school/residency were you able to get involved in research?

 

[Rolandicfissure]

Are you a medical student? How early in medical school/residency are you able to get involved in research?

I am, and you can start whenever you want. I worked on a project in the summer b/t 1st and 2nd year, and another one this (4th) year. It is a good opportunity to learn about interpreting data and the publishing process. More importantly, it is a way to cultivate good relationships with faculty members in your prospective specialty.

Just don't let it interfere with grades -- residency programs are far more interested in academic performance and board scores.

 

[50960]

Great posts everyone! It is nice to see some civility and honest answers! Keep posting..this is a good thread.

 

[twiggers]

I agree with what the one poster said about if you don't like hard sciences then med school isn't the right choice.
I originally thought about going MD route, but after a quarter of calc, chem, and 2 bios I was done. I figured there was no way I could hack it in med school.
I am personally glad about my choice. I will be in less debt, take less time to finish, and be doing something I love. Psychology was always the forefront of what I wanted to do, I just thought medicine would allow me to make the big bucks. As I've gotten older (and worked at alot of crappy jobs) I realize that money isn't everything

My advice would be to explore during your freshman/sophmore years. Take some hard science classes mixed with some psych classes. If you hate the science classes now (and be sure to throw in some chem/physics when experimenting) you'll probably hate them for the next 4 years in med school. Use your junior/senior year to confirm what you want to do. If you're still tossed up then do an internship in a hospital and one as a research assistant.
If you want to go clinical PhD route (and don't want to take a year off) try to get at least 1 full year as a research assistant in a psych lab.

 

[rpie]

Great posts everyone! It is nice to see some civility and honest answers! Keep posting..this is a good thread.

I wished all idea exchanges were like this. you all should look at the OD/MD posts. The mud throwing is in full force, and in many places the posts have degraded to using 4 lettered words.

Just a side note, there are now people trying to educated every as to what mid-level practioners do as noted in the below post.


"Since the public has trouble discerning the difference sometimes, it is our duty to show them the difference. The same goes for CRNA's, Psychologists, and other mid-levels looking to expand due to our own apathy and lack of patient knowledge. I was not aware of the numerous expansion of scope issues until midway through medical school. Nowadays, I try to make it a point to educate anyone I encounter during my clinical rotations whenever relevant. I know many of my classmates (especially those going into anesthesia and psych) are doing the same. For example, I can barely go a day or two without encountering a diabetic patient. During my H&P, I always ask them if they see an eye doctor yearly. I then ask if they see an ophthalmologist or optometrist, and if they don't know the difference, I use the opportunity to explain the difference in an objective manner. I know that if i (or more importantly...a family member) needed surgery, I'd go to (or recommend) an ophthalmologist who had an anesthesiologist (not a crna)"

BUCK Strong

 

[Sanman]

Why is it that some doctors in the medical profession feel that that they are the be all and end all in health care? Everybody has their place in the healthcare system. Are there turf wars, sure. But we need to work together. For those who don't believe that, perhaps you should open a community medical/mental health center with only docs (no nurses, psychologists or other "mid-level" practiioners). It would fold in a minute, especially with all the doctors arguing about doing the tasks that are "beneath" them. And to those crazy pre-med/ med students out there...not everyone becomes something else because we couldn't get into med school. Believe it or not the idea of being a slave for at least 7 years doesn't appeal to all of us. Don't get me wrong, doctors play an important role. Some just need to check the ego at the door.

 

[rpie]

I read some of the thread that the quote came out of. . . pretty funny. Opthamologists average somewhere around 300K a year, why are they so worked up about Optometrists? Life is good. Relative to M.D.s objectively educating patients as to the differences between psychology and psychiatry, I scoff. If this forum is an accurate representation, M.D.s don't know of what they speak. Unfortunately, psychology, as with other specialities medical and otherwise, is at the mercy of referral sources. M.D.s are the bulk of those referral sources for most practitioners. M.D.s have a lot of power in this relationship. There is really nothing for them to be worked up about. I don't quite understand why they want to relegate psychology to "mid-level" practitioner status. We are not nurses or social workers and our level of expertise is quite high with respect to our specialty. It is not something that can be replicated by a medical school education. We should be considered the "gold" standard of care. This isn't about ego, at least not from my perspective. I think the image of psychology in general is important to facilitating appropriate use of our skills. Lumping us in with midlevel providers diminishes our role in diagnosis and treatment. We become ancillary.

Since Psychologists have begun to get medication prescribing privileges, MDs have begun to get nervous and compares Psychology’s expansion to how OD’s got prescribing privileges in the 1970-1980’s. I believe the MD’s want to classify Psychologists to mid-level practitioners to designate the scope of medication prescribing privileges. However, you do make a good point about mid-level providers becoming ancillary.

In the case of MD/OD relations, majority of surgical referrals comes form the OD’s because Optometry does about 80% of all primary eye examination. Those Ophthalmologists that understands this usually have mutual respect for Optometry; work together co-managing surgical cases, and finds their practice flourishing.

 

[rpie]

That is one of the reasons that I think psychology should stay away from prescribing drugs.


A unique position for ODs to be sure, it gives them leverage. The synergy there should be quite good, but, on this board they seem to be at each other's throats.

I personally feel that as all Professions grow so must their scope of practice. As far as Psychologists prescribing, there are pros and cons that can be argued but I think that Psychologists prescriptive privileges will become standard with time.



This disharmony, it is because of a turf war. OD’s are requesting to add specific procedures into their scope of practice in order to provide full scope primary eye care, and the MDs are trying to stop and roll back the scope of practice. I will not elaborate any further since this is a Psychology board however, you are welcome to visit the OD board.

 

[LM02]

In the case of MD/OD relations, majority of surgical referrals comes form the OD’s because Optometry does about 80% of all primary eye examination. Those Ophthalmologists that understands this usually have mutual respect for Optometry; work together co-managing surgical cases, and finds their practice flourishing.

I really don't like to get involved in these kinds of discussions, but I have a great personal anecdote that I would love to share. I haven't been to an opthalmologist in several years, and finally decided that for my annual eye exam, I would skip the optometrist and head to the optho instead. So I call the optho to make an appt., and they promptly referred me to the optometrist and even transferred my phone call! So clearly they're not hurting if they are turning willing patients away...

 

[PsychMode]

I really don't like to get involved in these kinds of discussions, but I have a great personal anecdote that I would love to share. I haven't been to an opthalmologist in several years, and finally decided that for my annual eye exam, I would skip the optometrist and head to the optho instead. So I call the optho to make an appt., and they promptly referred me to the optometrist and even transferred my phone call! So clearly they're not hurting if they are turning willing patients away...

Although what you described was an MD referring to an OD, wouldn't it be nice if psychiatry and psychology were like this. Of course, OD education and training are different from clin psych education and training, but I think the mental field would have been different had psychiatrists utilized psychologists more (rather than anyone who called themselves therapists/counselors).

 

[PublicHealth]

I really don't like to get involved in these kinds of discussions, but I have a great personal anecdote that I would love to share. I haven't been to an opthalmologist in several years, and finally decided that for my annual eye exam, I would skip the optometrist and head to the optho instead. So I call the optho to make an appt., and they promptly referred me to the optometrist and even transferred my phone call! So clearly they're not hurting if they are turning willing patients away...

Because they're specialists! They spend their time conducting procedures (e.g., surgeries) instead of eye exams. Optometry is synonymous with "eye exams." That said, (this is a clin psych forum), neurologists and psychiatrists commonly refer patients to specialist psychologists such as neuropsychologists for difficult differential diagnoses or for assessment of cognitive deficits associated with dementia, brain injury, stroke, neurotoxic exposures, schizophrenia, ADHD, substance abuse/dependence, and related disorders. Forensic neuropsychologists are regularly involved in evaluating patients with suspected brain injury in personal injury or worker's comp cases. Mild traumatic brain injury (MTBI) is an intriguing area of research and clinical practice.

Clinical psychologists are increasingly pushing for employment in hospital settings in capacities such as behavioral medicine, health psychology, rehabilitation psychology, and neuropsychology. This is a good move for the field, as these specialties have much to offer. Unfortunately, APA's efforts have been centered on RxP because that's where the $$$ is. Efforts to demonstrate that psychologists serve an important role in traditional hospital settings is probably a better move toward ensuring viability of the profession.

 

[LM02]

Because they're specialists! They spend their time conducting procedures (e.g., surgeries) instead of eye exams. Optometry is synonymous with "eye exams." That said, (this is a clin psych forum), neurologists and psychiatrists commonly refer patients to specialist psychologists such as neuropsychologists for difficult differential diagnoses or for assessment of cognitive deficits associated with dementia, brain injury, stroke, neurotoxic exposures, schizophrenia, ADHD, substance abuse/dependence, and related disorders. Forensic neuropsychologists are regularly involved in evaluating patients with suspected brain injury in personal injury or worker's comp cases. Mild traumatic brain injury (MTBI) is an intriguing area of research and clinical practice.

Clinical psychologists are increasingly pushing for employment in hospital settings in capacities such as behavioral medicine, health psychology, rehabilitation psychology, and neuropsychology. This is a good move for the field, as these specialties have much to offer. Unfortunately, APA's efforts have been centered on RxP because that's where the $$$ is. Efforts to demonstrate that psychologists serve an important role in traditional hospital settings is probably a better move toward ensuring viability of the profession.

It was a metaphor. But not to get completely off topic, I have received regular ole eye exams from opthos several times in the past. And, on the other side, I've had optometrists tell me that every several years I should check in with the optho (and skip the OD) to make sure that there isn't anything alarming going on. So it's not an entirely clear-cut distinction.

Otherwise, I agree 100% with what you say about psychiatry and psychology. I've said it before, but I think the two fields are quite complementary - I've had my attending ask me to explain things to the residents (e.g., Skinnerian behavioral principles, the differences between efficacy & effectiveness studies, applications of brief cognitive therapy on an inpatient unit, etc.) and he's also asked the residents to educate me about pharmacotherapy and the organic basis of illness. Using this system, we mutually influence treatment and provide a service that is truly rooted in a biopsychosocial model. Despite some cynicism that I've seen on this message board, I've found that my real life experience has been much less adversarial and complicated than what people here make the field out to be (and, PublicHealth, I am not a naive student nor a PsyD).

 

[50960]

PH, please see "Congrats Ca" thread.