Psychiatry or psychology

[jamiediane1009]

Ok so i know this has been asked over and over and over again...but im really struggling with this. Ive been researching for almost one year...ive continued to take my pre reqs but it is getting to the point where i need to choose. My heart loves psychology because what i really want to do is talk to people one on one and find out their childhood issues, their background, or the trauma that happened in their life to figure out what actually happened to make this person the way they are...so it should be easy to say psychology and then done right? Not..I just dont think its right to go through 8 years of school which is only a couple years less then psychiatry and get paid starting pay of 50-70,000. Im going to accumulate debt also. Paying off debt and getting paid 50-70,000 is going to be a struggle. So then i keep going back to psychiatry because i feel like with that salary ill have a chance to pay off debt and still live comfortably. My problem though is psychiatrists now a days are just med evaluaters and like i stated i want to get to know the person and what made them this way. With all that being said any kind of advice would be lovely. Thanks

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[st2205]

Psychiatrists and psychologists certainly do have different mean incomes. However, with few exception, you likely won't be making a psychiatrist's income "talk[ing] to people one on one and find[ing] out their childhood issues, their background, or the trauma that happened in their life to figure out what actually happened to make this person the way they are." Sure, some may say you could be a successful, cash-based psychiatrist offering therapy, but I'd counter with saying you could also be a successful, cash-based psychologist offering therapy. Both are not super likely and aren't the norm, but it's not like the chances of winning the lottery. You've just got to be realistic about it.

 

[wolfvgang22]

jamiediane1009, I thought exactly as you do when I was a student. Also, I think you are absolutely right about the time and money aspect.

I started out wanting to be a clinical psychologist, but dropped out of my graduate psychology program after working in a public mental health clinic with both psychologists and psychiatrists for two years.

I preferred psychology back then. Psychology was more familiar, and thus easier for me. The stakes weren't very high for me to become a psychologist. Back then, I was not really interested in lots of medical topics or the math that I needed just to get into med school, but I was intensely interested in both clinical and experimental psychology. Grad school was easy.
For me, medical school was the much more difficult path, I wasn't sure if I would make it.

But, I had $65K in private school undergrad loans. Reality set in. I thought I would never pay off my student loans as a psychologist, much less buy a house, or travel. I decided to suck it up and push my limits. I decided to eat, live, and breathe becoming an psychiatrist, which requires becoming an MD first. Over time, I learned to relish the challenge and learned to appreciate and sometimes love subjects I didn't think I would ever like, such as anatomy, and later, disciplines like internal medicine and Ob/Gyn. I learned to love the challenge, and overcoming the challenge stoked my ego.

I would be struggling financially as a clinical psychologist in my region, with the student loans. Now, I'm not. Not only that, but employers are helping me pay off my debt. I could take a $100k pay cut and still make more than the highest paid psychologist in my city.

Okay, some of what I'm going to write now might annoy some psychologists, but I'm telling it how it is.
I do a lot of therapy in my current position, so I don't regret my choice at all. I think what I do, combining medication management and therapy, is much more challenging than if I just did one of those things. I'm good at both, because I received excellent training in both while in an excellent residency.
I do have more responsibility for people's lives than my psychologist colleagues. That is just how it is. I am on call overnight for emergencies. My psychologist friends are not. Many times I don't get breaks or lunch. I see psychologists at my hospital lounging in the hall, working less hard for less money, seeing less patients. I prescribe dangerous drugs all day, it can be scary. I can place patients in the hospital against their will, and briefly suspend their freedom to protect themselves and society, and I have to justify that action to the court in a legal document. The psychologist can't do that under current law. I'm at a higher risk of being sued than the psychologist. But I love being able to do MORE for the patient as he or she recovers from illness.

I can tell the difference between a neurological, psychological, substance abuse, or medical problem that is causing cognitive and behavioral symptoms. I can diagnose conditions like hyponatremia, hypokalemia, hypocalcemia, syphilis, anemia, parkinson's, tourette's, pseudobulbar affect, dementia, depression, ADHD, panic disorder, schizophrenia, and personality disorders just to name a very few, and treat them ALL with therapy and medication. I diagnosed and started treating patients for all these examples just this week. How cool is that? Psychologists just can't match that range of knowledge and practice. I cured one woman's depression just by prescribing her vitamin D recently, because I discovered a deficiency on a lab I ordered. That felt good, and psychiatrists do it all the time.

The buck stops here when it comes to the patient's health and safety. If you don't want hard work and great responsibility, medicine is not for you. But like most doctors, I love it, and have an ego to match the challenge. Most psychologists generally just don't have the swagger and intensity we MDs have. I sure as heck didn't used to when I was in grad school. Medicine did change my personality into a much more driven and perfectionistic person. I've had to learn when to turn that off at my (large) home.

I'm in no way saying psychology is inferior, or that money is the only thing in life that matters, or that it is a bad choice. I'm just telling you what I did when I was in your position.
For me, becoming a psychiatrist has been an awesome journey that has enriched my life in almost every way, and I'd do it again.

 

[jamiediane1009]

jamiediane1009, I thought exactly as you do when I was a student. Also, I think you are absolutely right about the time and money aspect.

I started out wanting to be a clinical psychologist, but dropped out of my graduate psychology program after working in a public mental health clinic with both psychologists and psychiatrists for two years.

I preferred psychology back then. Psychology was more familiar, and thus easier for me. The stakes weren't very high for me to become a psychologist. Back then, I was not really interested in lots of medical topics or the math that I needed just to get into med school, but I was intensely interested in both clinical and experimental psychology. Grad school was easy.
For me, medical school was the much more difficult path, I wasn't sure if I would make it.

But, I had $65K in private school undergrad loans. Reality set in. I thought I would never pay off my student loans as a psychologist, much less buy a house, or travel. I decided to suck it up and push my limits. I decided to eat, live, and breathe becoming an psychiatrist, which requires becoming an MD first. Over time, I learned to relish the challenge and learned to appreciate and sometimes love subjects I didn't think I would ever like, such as anatomy, and later, disciplines like internal medicine and Ob/Gyn. I learned to love the challenge, and overcoming the challenge stoked my ego.

I would be struggling financially as a clinical psychologist in my region, with the student loans. Now, I'm not. Not only that, but employers are helping me pay off my debt. I could take a $100k pay cut and still make more than the highest paid psychologist in my city.

Okay, some of what I'm going to write now might annoy some psychologists, but I'm telling it how it is.
I do a lot of therapy in my current position, so I don't regret my choice at all. I think what I do, combining medication management and therapy, is much more challenging than if I just did one of those things. I'm good at both, because I received excellent training in both while in an excellent residency.
I do have more responsibility for people's lives than my psychologist colleagues. That is just how it is. I am on call overnight for emergencies. My psychologist friends are not. Many times I don't get breaks or lunch. I see psychologists at my hospital lounging in the hall, working less hard for less money, seeing less patients. I prescribe dangerous drugs all day, it can be scary. I can place patients in the hospital against their will, and briefly suspend their freedom to protect themselves and society, and I have to justify that action to the court in a legal document. The psychologist can't do that under current law. I'm at a higher risk of being sued than the psychologist. But I love being able to do MORE for the patient as he or she recovers from illness.

I can tell the difference between a neurological, psychological, substance abuse, or medical problem that is causing cognitive and behavioral symptoms. I can diagnose conditions like hyponatremia, hypokalemia, hypocalcemia, syphilis, anemia, parkinson's, tourette's, pseudobulbar affect, dementia, depression, ADHD, panic disorder, schizophrenia, and personality disorders just to name a very few, and treat them ALL with therapy and medication. I diagnosed and started treating patients for all these examples just this week. How cool is that? Psychologists just can't match that range of knowledge and practice. I cured one woman's depression just by prescribing her vitamin D recently, because I discovered a deficiency on a lab I ordered. That felt good, and psychiatrists do it all the time.

The buck stops here when it comes to the patient's health and safety. If you don't want hard work and great responsibility, medicine is not for you. But like most doctors, I love it, and have an ego to match the challenge. Most psychologists generally just don't have the swagger and intensity we MDs have. I sure as heck didn't used to when I was in grad school. Medicine did change my personality into a much more driven and perfectionistic person. I've had to learn when to turn that off at my (large) home.

I'm in no way saying psychology is inferior, or that money is the only thing in life that matters, or that it is a bad choice. I'm just telling you what I did when I was in your position.
For me, becoming a psychiatrist has been an awesome journey that has enriched my life in almost every way, and I'd do it again.

Wow reading that was incredibly exhilarating! Definitely reminded me of my personality and as you were talking about being able to help people by figuring out the lady had a vitamin deficiency and all that other stuff I got super excited I am pretty sure I'm going psychiatry now lol

 

[Dr. Hip]

If you want to be a complete mental health healer you need to understand the body as well. Pathology in the body can cause pathology in the mind and you can vice that verse as well. Basically I second wolvgangs post.

 

[wolfvgang22]

I currently work in an outpatient clinic at a VA hospital and provide consultation services to the ER, medical floor, and nursing facility at the VA. I specialize in treating veterans who served in Operation Iraqi Freedom and Operation Enduring Freedom in my clinic. Many psychiatrists work full time in a psychiatric hospital or a mix of inpatient and outpatient clinic.

 

[deleted343839]

Okay, some of what I'm going to write now might annoy some psychologists, but I'm telling it how it is.
I do a lot of therapy in my current position, so I don't regret my choice at all. I think what I do, combining medication management and therapy, is much more challenging than if I just did one of those things. I'm good at both, because I received excellent training in both while in an excellent residency.
I do have more responsibility for people's lives than my psychologist colleagues. That is just how it is. I am on call overnight for emergencies. My psychologist friends are not. Many times I don't get breaks or lunch. I see psychologists at my hospital lounging in the hall, working less hard for less money, seeing less patients. I prescribe dangerous drugs all day, it can be scary. I can place patients in the hospital against their will, and briefly suspend their freedom to protect themselves and society, and I have to justify that action to the court in a legal document. The psychologist can't do that under current law. I'm at a higher risk of being sued than the psychologist. But I love being able to do MORE for the patient as he or she recovers from illness.

I can tell the difference between a neurological, psychological, substance abuse, or medical problem that is causing cognitive and behavioral symptoms. I can diagnose conditions like hyponatremia, hypokalemia, hypocalcemia, syphilis, anemia, parkinson's, tourette's, pseudobulbar affect, dementia, depression, ADHD, panic disorder, schizophrenia, and personality disorders just to name a very few, and treat them ALL with therapy and medication. I diagnosed and started treating patients for all these examples just this week. How cool is that? Psychologists just can't match that range of knowledge and practice. I cured one woman's depression just by prescribing her vitamin D recently, because I discovered a deficiency on a lab I ordered. That felt good, and psychiatrists do it all the time.

As a psychologist, I think this is a pretty fair assessment.

My story follows the opposite trajectory. I was initially interested in medicine, took all my pre-med courses, worked in several hospital settings, and tried to get a feel for medicine as best as I could, at least by a college student's standards. Then I started working in research labs during my junior year of college and it surprised me how much I enjoyed it. It wasn't until after graduation that I made the decision to apply to graduate school, and I have few regrets. I like my work, and I enjoy having plenty of time to spend with my family and also pursue side projects such as the book I'm writing for one of the major publishers in my field. I appreciate the time I have to think, and to write, secure in the knowledge that my pager is unlikely to go off and I'm sure as heck not going to get a call about an abnormal lab result or freak medication side effect right when I'm sitting down to dinner or putting my kids to bed. Now, after I put the kids to bed, I may lose many hours of sleep working on a grant, a paper, or a book manuscript, but that pain is largely self-inflicted.

Psychiatrists, with the right training, have the full spectrum of tools to manage mental disorders at their disposal. Psychologists are behavioral scientists - sometimes in the more applied sense, sometimes in the more scholarly sense, and sometimes both. Many psychologists are also skilled and intuitive therapists, but the underlying philosophies of medicine and psychology differ in important ways that can affect even how we provide therapy. On a practical note, I'm often relieved that I don't have the burden of a prescription pad. I've worked in subspecialty medicine with a fairly niche focus, which scratches my itch for novelty while leaving me plenty of room to hone my therapy practice and contribute to the knowledge base in my area.

Wow reading that was incredibly exhilarating! Definitely reminded me of my personality and as you were talking about being able to help people by figuring out the lady had a vitamin deficiency and all that other stuff I got super excited I am pretty sure I'm going psychiatry now lol

Well, that was easy. If you are primarily interested in treating people with mental disorders, and you want to be able to use that complete range of tools, then it is worth doing the hard work of becoming a psychiatrist. You will likely have more "wow" moments of this sort in your career. If you are interested in developing those tools (whether assessment, therapy, or meds -- psychologists and other types of scientists are involved in all of these), then you might consider training in a scientific discipline, including but not limited to psychology.

That Vitamin D thing also could have been placebo response, though.

 

[MacDonaldTriad]

Thank god for placebo responses, without them we would be less than half as effective as we are today. We have been described as medicine men with a handful of evidence based trials and I think that is a fair characterization. If placebo controls included chicken guts and white powder we probably wouldn't have any statistical significance.

 

[deleted343839]

Thank god for placebo responses, without them we would be less than half as effective as we are today. We have been described as medicine men with a handful of evidence based trials and I think that is a fair characterization. If placebo controls included chicken guts and white powder we probably wouldn't have any statistical significance.

Amen to that. We love to overvalue the specific effects of our treatments, but in truth placebos are friends to all.

I've provided both pill placebo and "sham therapy" (i.e., exposure to nonspecific factors) in randomized trials. On one hand, it's humbling. On the other hand, it's awesome to see someone who really wants to get better use whatever they're given and somehow make it work.

 

[nexus73]

Lookup the difficulty (bottleneck) of psychology internship, which is a requirement after your phd. Makes residency competition look like a walk in the park.

 

[smalltownpsych]

jamiediane1009, I thought exactly as you do when I was a student. Also, I think you are absolutely right about the time and money aspect.

I started out wanting to be a clinical psychologist, but dropped out of my graduate psychology program after working in a public mental health clinic with both psychologists and psychiatrists for two years.

I preferred psychology back then. Psychology was more familiar, and thus easier for me. The stakes weren't very high for me to become a psychologist. Back then, I was not really interested in lots of medical topics or the math that I needed just to get into med school, but I was intensely interested in both clinical and experimental psychology. Grad school was easy.
For me, medical school was the much more difficult path, I wasn't sure if I would make it.

But, I had $65K in private school undergrad loans. Reality set in. I thought I would never pay off my student loans as a psychologist, much less buy a house, or travel. I decided to suck it up and push my limits. I decided to eat, live, and breathe becoming an psychiatrist, which requires becoming an MD first. Over time, I learned to relish the challenge and learned to appreciate and sometimes love subjects I didn't think I would ever like, such as anatomy, and later, disciplines like internal medicine and Ob/Gyn. I learned to love the challenge, and overcoming the challenge stoked my ego.

I would be struggling financially as a clinical psychologist in my region, with the student loans. Now, I'm not. Not only that, but employers are helping me pay off my debt. I could take a $100k pay cut and still make more than the highest paid psychologist in my city.

Okay, some of what I'm going to write now might annoy some psychologists, but I'm telling it how it is.
I do a lot of therapy in my current position, so I don't regret my choice at all. I think what I do, combining medication management and therapy, is much more challenging than if I just did one of those things. I'm good at both, because I received excellent training in both while in an excellent residency.
I do have more responsibility for people's lives than my psychologist colleagues. That is just how it is. I am on call overnight for emergencies. My psychologist friends are not. Many times I don't get breaks or lunch. I see psychologists at my hospital lounging in the hall, working less hard for less money, seeing less patients. I prescribe dangerous drugs all day, it can be scary. I can place patients in the hospital against their will, and briefly suspend their freedom to protect themselves and society, and I have to justify that action to the court in a legal document. The psychologist can't do that under current law. I'm at a higher risk of being sued than the psychologist. But I love being able to do MORE for the patient as he or she recovers from illness.

I can tell the difference between a neurological, psychological, substance abuse, or medical problem that is causing cognitive and behavioral symptoms. I can diagnose conditions like hyponatremia, hypokalemia, hypocalcemia, syphilis, anemia, parkinson's, tourette's, pseudobulbar affect, dementia, depression, ADHD, panic disorder, schizophrenia, and personality disorders just to name a very few, and treat them ALL with therapy and medication. I diagnosed and started treating patients for all these examples just this week. How cool is that? Psychologists just can't match that range of knowledge and practice. I cured one woman's depression just by prescribing her vitamin D recently, because I discovered a deficiency on a lab I ordered. That felt good, and psychiatrists do it all the time.

The buck stops here when it comes to the patient's health and safety. If you don't want hard work and great responsibility, medicine is not for you. But like most doctors, I love it, and have an ego to match the challenge. Most psychologists generally just don't have the swagger and intensity we MDs have. I sure as heck didn't used to when I was in grad school. Medicine did change my personality into a much more driven and perfectionistic person. I've had to learn when to turn that off at my (large) home.

I'm in no way saying psychology is inferior, or that money is the only thing in life that matters, or that it is a bad choice. I'm just telling you what I did when I was in your position.
For me, becoming a psychiatrist has been an awesome journey that has enriched my life in almost every way, and I'd do it again.

Too many lazy psychologists out there, that's for sure.
I just wanted to counter that in this state and the last one that I worked in, I can also order an emergency detention and conduct evaluations for the determination of involuntary commitment and testify in court. Also, very few psychiatrists can match my level of psychological knowledge and practice cause their brains really aren't twice as big and we can only have so much expertise. When it comes to implementing a variety of interventions for a wide variety of disorders with a variety of populations, I don't feel that I take a back seat to anybody. The truth is being able to effect change without using medications is often what is really needed and since I don't have to worry about the meds then I focus on everything else. It is true that I wish I had more medical knowledge and I do enjoy discussing with my medical colleagues some of the interactions between our endeavors and at times feel that it would be useful to be able to add psychotropics to my tool kit, but I would not personally sacrifice my current skill set for psychiatry for that reason alone. Sometimes the double the money thing gets to me though.

I probably could have gone either route and been happy to be completely honest, but am more than satisfied with the route that I chose.

 

[wolfvgang22]

I wish sometimes that placebo wasn't widely considered unethical, as I think a sugar pill would help a few of my medication seeking patients.

I don't think the vitamin D was a placebo response in my 42 year old female patient's case, however. Her cognition, memory, and mood all improved objectively per testing by our competent psychologist as her 25-hydroxyvitamin D levels improved from <10 ng/ml to 40 ng/ml. Her serum calcium also improved as expected. I suspect she had secondary hyperparathyroidism because muscle fatigue and aches she had for months also resolved. I did not measure her PTH, foolishly believing her primary care doctor might. I'll follow up on her calcium, Vit D, and watch out for hyperparathyroidism when I see her next month. Could her reduction in symptoms be a mere correlation with the Vitamin D replenishment? Possibly, but unlikely in my opinion. I'm still going to recommend she go ahead and try psychotherapy.

 

[LasVagus]

I was struggling with the same decision 10 years ago and I ultimately chose psychiatry. For me I think that the big intellectual difference is a matter of breadth vs. depth. As smalltownpsych alluded to above, there's only so much you can store in one brain. Given that you will likely be an equally invested clinician going either route, the difference will not be how much you know, but rather how that knowledge is distributed. A psychiatrist will treat the entire breadth of mental illness from delirium to behavioral disturbances associated with TBIs to acute mania to catatonia, whereas a clinical psychologist will use the same sized brain to focus on the subset of patients who are able to address their issues verbally in a psychotherapeutic context and they will, therefore, have a much deeper understanding of that population.

I chose psychiatry because I like the variety and I like having all of the tools at my disposal. That being said, I can't tell you how many times I have seen a patient who is being treated with a number of medications who would clearly be better off with therapy alone. I want to toss out the pills and the DSM and scream: "stop hiding behind the medical model of mental illness; you've got a lot of work to do in therapy and you're avoiding it!" Psychotherapy may be one tool, but it's often the most important one.

We need good psychiatrists and good psychologists. I don't personally care which route you go as long as you're thoughtful about it and are committed to helping this vulnerable population. Best of luck in your journey!

 

[tr]

Thank god for placebo responses, without them we would be less than half as effective as we are today.

As would all other types of physicians, given the very significant placebo effects demonstrable across all branches of medicine.

Hypertension
http://hyper.ahajournals.org/content/65/2/401
Osteoarthritis
https://www.ncbi.nlm.nih.gov/pubmed/18541604
Asthma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351653/

Etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832199/

 

[tr]

That Vitamin D thing also could have been placebo response, though.

Probably not. Vitamin D deficiency is endemic in the US and has very well established links to depression. Vitamin D level is part of my standard intake for anyone with a mood disorder unless they've had it checked in the past 3 years or are already taking supplementation. I'd say a good 40-50% of the time I find serum D levels below 25 (which is min threshold for basic bone health; depressive effect kicks in at serum levels of 40 and below). Supplementation often has dramatic effects (I do also tell people to go out in the sun).

It's way higher yield than checking TSH, which I also do regularly but almost never actually find to be abnormal.

 

[Merovinge]

Thank god for placebo responses, without them we would be less than half as effective as we are today. We have been described as medicine men with a handful of evidence based trials and I think that is a fair characterization. If placebo controls included chicken guts and white powder we probably wouldn't have any statistical significance.

Is your white powder by chance a derivative of the coca plant?

 

[wolfvgang22]

Not to derail the thread or anything, but I've been seeing a lot more vitamin D deficiency over the last 18 months in clinic. And I'm not looking for it any more than I used to. My colleagues here have noticed it, too.

 

[deleted343839]

Could her reduction in symptoms be a mere correlation with the Vitamin D replenishment? Possibly, but unlikely in my opinion.

Probably not. Vitamin D deficiency is endemic in the US and has very well established links to depression.

Good to know. My impression was that the jury was still out on Vitamin D supplementation given some pertinent negative/inconclusive findings, but I don't really follow that literature. All I know is that the waters have been muddied with studies of people without Vitamin D deficiency. Have the RCTs been consistent with regard to depression outcomes, at least in the setting of Vitamin D deficiency?

 

[tr]

Good to know. My impression was that the jury was still out on Vitamin D supplementation given some pertinent negative/inconclusive findings, but I don't really follow that literature. All I know is that the waters have been muddied with studies of people without Vitamin D deficiency. Have the RCTs been consistent with regard to depression outcomes, at least in the setting of Vitamin D deficiency?

Meta-analyses suggest that results from well-designed studies that focus on subjects with both clinically significant depression and demonstrable D deficiency are positive. (Admittedly there are only a few of these.) There are a bunch of negative ones as well but those mostly either looked at effects on subclinical depressive symptoms, weren't D deficient as you note, or had other methodological flaws.

https://www.ncbi.nlm.nih.gov/pubmed/24732019
https://www.ncbi.nlm.nih.gov/pubmed/24632894

I think a pertinent confounding issue is whether D deficiency is causative of depression, or simply a marker for insufficient sun exposure. The results of the few available good-quality RCTs for supplementation do support that the former plays a role, but it could still be a dual effect and as I said I hedge my bets by prescribing 15-30 minutes of AM sun exposure qd as well.

 

[wolfvgang22]

We would need more evidence before we could say Vitamin D deficiency causes Major Depressive Disorder directly. It probably doesn't.

However, the well known effects of vitamin D deficiency medically, such as hypocalcemia, hypophosphotemia, fatigue, miscle aches, osteomalacia, and it's association with other diseases like hypoparathyroidism, celiac disease, etc. These things will all definitely affect cognition and mood according to evidence and look a lot like Major Depressive Disorder and must be corrected to alleviate symptoms. The correct diagnosis is not Major Depressive Disorder here, but Depressive Disorder Due to Another Medical Condition.

 

[deleted343839]

However, the well known effects of vitamin D deficiency medically, such as hypocalcemia, hypophosphotemia, fatigue, miscle aches, osteomalacia, and it's association with other diseases like hypoparathyroidism, celiac disease, etc. These things will all definitely affect cognition and mood according to evidence and look a lot like Major Depressive Disorder and must be corrected to alleviate symptoms. The correct diagnosis is not Major Depressive Disorder here, but Depressive Disorder Due to Another Medical Condition.

Thank you (and @tr). I learned something new today.

 

[Monocles]

Pgy-1 psych resident here, also struggled with the same debate way back in the days.

I'm hoping to do child/adolescent psychiatry some day and do therapy with teenagers (I feel meh about meds). Went the MD route obviously, but some of the downsides include:

- Hating all of pre-med courses (biology, chemistry, physics) while loving psychology (my major)
- Hating all of pre-clinical year 1&2 stuff in med school, hating every rotation except peds and psych during years 3&4 (loved those!)
- Hating all none psych rotations in residency, and even a lot of the more medically complicated psych ones (geri, CL)

So right now I feel like I'm white knuckling through 11 years of my life just to get to what I want to do (work with teens), and whether or not it's worth all the misery depends from person to person...

 

[smalltownpsych]

We would need more evidence before we could say Vitamin D deficiency causes Major Depressive Disorder directly. It probably doesn't.

However, the well known effects of vitamin D deficiency medically, such as hypocalcemia, hypophosphotemia, fatigue, miscle aches, osteomalacia, and it's association with other diseases like hypoparathyroidism, celiac disease, etc. These things will all definitely affect cognition and mood according to evidence and look a lot like Major Depressive Disorder and must be corrected to alleviate symptoms. The correct diagnosis is not Major Depressive Disorder here, but Depressive Disorder Due to Another Medical Condition.

Up here in the far north, we see a significant amount of vitamin D deficiency as well as an increased prevalence of SAD, of course. Not only do we have much less sunlight available, but people don't like the cold so they tend to stay indoors and are much less active. Sometimes it is impossible to tease out all of the variables that correlate in all of this so I just ski alot and I don't have to worry about it.

 

[Merovinge]

Pgy-1 psych resident here, also struggled with the same debate way back in the days.

I'm hoping to do child/adolescent psychiatry some day and do therapy with teenagers (I feel meh about meds). Went the MD route obviously, but some of the downsides include:

- Hating all of pre-med courses (biology, chemistry, physics) while loving psychology (my major)
- Hating all of pre-clinical year 1&2 stuff in med school, hating every rotation except peds and psych during years 3&4 (loved those!)
- Hating all none psych rotations in residency, and even a lot of the more medically complicated psych ones (geri, CL)

So right now I feel like I'm white knuckling through 11 years of my life just to get to what I want to do (work with teens), and whether or not it's worth all the misery depends from person to person...

While not the experience of all psychiatrists, I think its very important for pre-med folks to hear about your experience so major kuddos for sharing. Adolescent work is the absolute best, so I do hope you find it all worth it, but it's certainly possible a different route would have been better for you (if you were to go back in time and do it all again).

 

[singasongofjoy]

Not to derail the thread or anything, but I've been seeing a lot more vitamin D deficiency over the last 18 months in clinic. And I'm not looking for it any more than I used to. My colleagues here have noticed it, too.

Interesting - I overheard a similar conversation relatively recently- what general area of the country are you in?

 

[nowaysanjose]

jamiediane1009, I thought exactly as you do when I was a student. Also, I think you are absolutely right about the time and money aspect.

I started out wanting to be a clinical psychologist, but dropped out of my graduate psychology program after working in a public mental health clinic with both psychologists and psychiatrists for two years.

I preferred psychology back then. Psychology was more familiar, and thus easier for me. The stakes weren't very high for me to become a psychologist. Back then, I was not really interested in lots of medical topics or the math that I needed just to get into med school, but I was intensely interested in both clinical and experimental psychology. Grad school was easy.
For me, medical school was the much more difficult path, I wasn't sure if I would make it.

But, I had $65K in private school undergrad loans. Reality set in. I thought I would never pay off my student loans as a psychologist, much less buy a house, or travel. I decided to suck it up and push my limits. I decided to eat, live, and breathe becoming an psychiatrist, which requires becoming an MD first. Over time, I learned to relish the challenge and learned to appreciate and sometimes love subjects I didn't think I would ever like, such as anatomy, and later, disciplines like internal medicine and Ob/Gyn. I learned to love the challenge, and overcoming the challenge stoked my ego.

I would be struggling financially as a clinical psychologist in my region, with the student loans. Now, I'm not. Not only that, but employers are helping me pay off my debt. I could take a $100k pay cut and still make more than the highest paid psychologist in my city.

Okay, some of what I'm going to write now might annoy some psychologists, but I'm telling it how it is.
I do a lot of therapy in my current position, so I don't regret my choice at all. I think what I do, combining medication management and therapy, is much more challenging than if I just did one of those things. I'm good at both, because I received excellent training in both while in an excellent residency.
I do have more responsibility for people's lives than my psychologist colleagues. That is just how it is. I am on call overnight for emergencies. My psychologist friends are not. Many times I don't get breaks or lunch. I see psychologists at my hospital lounging in the hall, working less hard for less money, seeing less patients. I prescribe dangerous drugs all day, it can be scary. I can place patients in the hospital against their will, and briefly suspend their freedom to protect themselves and society, and I have to justify that action to the court in a legal document. The psychologist can't do that under current law. I'm at a higher risk of being sued than the psychologist. But I love being able to do MORE for the patient as he or she recovers from illness.

I can tell the difference between a neurological, psychological, substance abuse, or medical problem that is causing cognitive and behavioral symptoms. I can diagnose conditions like hyponatremia, hypokalemia, hypocalcemia, syphilis, anemia, parkinson's, tourette's, pseudobulbar affect, dementia, depression, ADHD, panic disorder, schizophrenia, and personality disorders just to name a very few, and treat them ALL with therapy and medication. I diagnosed and started treating patients for all these examples just this week. How cool is that? Psychologists just can't match that range of knowledge and practice. I cured one woman's depression just by prescribing her vitamin D recently, because I discovered a deficiency on a lab I ordered. That felt good, and psychiatrists do it all the time.

The buck stops here when it comes to the patient's health and safety. If you don't want hard work and great responsibility, medicine is not for you. But like most doctors, I love it, and have an ego to match the challenge. Most psychologists generally just don't have the swagger and intensity we MDs have. I sure as heck didn't used to when I was in grad school. Medicine did change my personality into a much more driven and perfectionistic person. I've had to learn when to turn that off at my (large) home.

I'm in no way saying psychology is inferior, or that money is the only thing in life that matters, or that it is a bad choice. I'm just telling you what I did when I was in your position.
For me, becoming a psychiatrist has been an awesome journey that has enriched my life in almost every way, and I'd do it again.

Are psychiatrists regularly treating Parkinsons with carbidopa/levodopa, COMTi, etc?

 

[wolfvgang22]

No, but depression is a common comorbidity of Parkinson's. I have been the first physician to diagnose Parkinson's in several patients, who I then refer to the neurologist for treatment. This happens with lots of disorders. Many psychiatric patients come to us with a mood or behavioral chief complaint, and the psychiatrist discovers other ailments that need attention due to our experience and knowledge of signs and symptoms of disease. It is rewarding.

 

[nowaysanjose]

Would there ever be a situation where you would? Say like geri, neuropsych, undeserved population, etc?

 

[st2205]

Would there ever be a situation where you would? Say like geri, neuropsych, undeserved population, etc?

No. I'm sure you can find an exception to this somewhere but the answer is no. Treating and managing HTN, DMII, hyperlipidemia, etc., is one thing. Managing Parkinson's is quite another. That's not even a realm PCPs go into.

 

[hamstergang]

I don't think the vitamin D was a placebo response in my 42 year old female patient's case, however. Her cognition, memory, and mood all improved objectively per testing by our competent psychologist as her 25-hydroxyvitamin D levels improved from <10 ng/ml to 40 ng/ml.

I'm not sure I get how you can tell this wasn't a placebo response. You'd expect the symptoms to improve objectively and subjectively along with the vitamin D levels increasing whether it was a placebo response or not. How can you tell the difference?

 

[Dharma]

Thank god for placebo responses, without them we would be less than half as effective as we are today. We have been described as medicine men with a handful of evidence based trials and I think that is a fair characterization. If placebo controls included chicken guts and white powder we probably wouldn't have any statistical significance.

Although, not completely on-topic, but an interesting article regarding expected response in recent green book is worth the read:

http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2016.16020225

Would there ever be a situation where you would? Say like geri, neuropsych, undeserved population, etc?

Diagnosis is sometimes the most exciting (and important) part!

 

[hamstergang]

Pretend this post doesn't exist.

 

[smalltownpsych]

I'm not sure I get how you can tell this wasn't a placebo response. You'd expect the symptoms to improve objectively and subjectively along with the vitamin D levels increasing whether it was a placebo response or not. How can you tell the difference?

Without a double-blind experiment with a control group? No one can.

Nevertheless, in order to stay sane in this field, we have to take a little credit for placebo response though. In other words, when my patients improve, I tend to assume that it is from the treatment effects of the empirically derived evidenced based treatment I so brilliantly chose even though spontaneous remission, regression to the mean, and placebo effects are all at play. Otherwise, I am just left with the massive resistance of the many patients who do not improve and actually get worse as they continue on their self-destructive path.

 

[Mellowmish]

jamiediane1009, I thought exactly as you do when I was a student. Also, I think you are absolutely right about the time and money aspect.

I started out wanting to be a clinical psychologist, but dropped out of my graduate psychology program after working in a public mental health clinic with both psychologists and psychiatrists for two years.

I preferred psychology back then. Psychology was more familiar, and thus easier for me. The stakes weren't very high for me to become a psychologist. Back then, I was not really interested in lots of medical topics or the math that I needed just to get into med school, but I was intensely interested in both clinical and experimental psychology. Grad school was easy.
For me, medical school was the much more difficult path, I wasn't sure if I would make it.

But, I had $65K in private school undergrad loans. Reality set in. I thought I would never pay off my student loans as a psychologist, much less buy a house, or travel. I decided to suck it up and push my limits. I decided to eat, live, and breathe becoming an psychiatrist, which requires becoming an MD first. Over time, I learned to relish the challenge and learned to appreciate and sometimes love subjects I didn't think I would ever like, such as anatomy, and later, disciplines like internal medicine and Ob/Gyn. I learned to love the challenge, and overcoming the challenge stoked my ego.

I would be struggling financially as a clinical psychologist in my region, with the student loans. Now, I'm not. Not only that, but employers are helping me pay off my debt. I could take a $100k pay cut and still make more than the highest paid psychologist in my city.

Okay, some of what I'm going to write now might annoy some psychologists, but I'm telling it how it is.
I do a lot of therapy in my current position, so I don't regret my choice at all. I think what I do, combining medication management and therapy, is much more challenging than if I just did one of those things. I'm good at both, because I received excellent training in both while in an excellent residency.
I do have more responsibility for people's lives than my psychologist colleagues. That is just how it is. I am on call overnight for emergencies. My psychologist friends are not. Many times I don't get breaks or lunch. I see psychologists at my hospital lounging in the hall, working less hard for less money, seeing less patients. I prescribe dangerous drugs all day, it can be scary. I can place patients in the hospital against their will, and briefly suspend their freedom to protect themselves and society, and I have to justify that action to the court in a legal document. The psychologist can't do that under current law. I'm at a higher risk of being sued than the psychologist. But I love being able to do MORE for the patient as he or she recovers from illness.

I can tell the difference between a neurological, psychological, substance abuse, or medical problem that is causing cognitive and behavioral symptoms. I can diagnose conditions like hyponatremia, hypokalemia, hypocalcemia, syphilis, anemia, parkinson's, tourette's, pseudobulbar affect, dementia, depression, ADHD, panic disorder, schizophrenia, and personality disorders just to name a very few, and treat them ALL with therapy and medication. I diagnosed and started treating patients for all these examples just this week. How cool is that? Psychologists just can't match that range of knowledge and practice. I cured one woman's depression just by prescribing her vitamin D recently, because I discovered a deficiency on a lab I ordered. That felt good, and psychiatrists do it all the time.

The buck stops here when it comes to the patient's health and safety. If you don't want hard work and great responsibility, medicine is not for you. But like most doctors, I love it, and have an ego to match the challenge. Most psychologists generally just don't have the swagger and intensity we MDs have. I sure as heck didn't used to when I was in grad school. Medicine did change my personality into a much more driven and perfectionistic person. I've had to learn when to turn that off at my (large) home.

I'm in no way saying psychology is inferior, or that money is the only thing in life that matters, or that it is a bad choice. I'm just telling you what I did when I was in your position.
For me, becoming a psychiatrist has been an awesome journey that has enriched my life in almost every way, and I'd do it again.

I'm so inspired, thank you for taking the time out to respond to this. Also, do you have any advice for overly sensitive/empathetic people who want to enter this profession. How does one combat compassion fatigue, and make sure while saving others from drowning, that they too stay afloat?

 

[AcronymAllergy]

Not to derail the thread or anything, but I've been seeing a lot more vitamin D deficiency over the last 18 months in clinic. And I'm not looking for it any more than I used to. My colleagues here have noticed it, too.

Again, not to derail, but our psychiatrists (also at a VA clinic) catch vitamin D deficiency all. The. Time. Thank y'all, btw. Probably half, if not more, of the folks I see pop for it at some point.