Psychiatry vs Mental Health Nurse Practitioner Route - Seeking Advice

[tarheel919]

I'm having a lot of difficulty deciding whether I should pursue a career in Psychiatry (MD) or become a Mental Health Nurse Practitioner (MHNP).

Background: I'm 27 years old and have extensive background/publications in mental health research at various prestigious universities. I'd always planned to do a PhD program in some branch of Evidence-Based Psychology, but over the years I've realized I'd rather work primarily with patients in a clinical setting rather than pursuing research.

Here are a few other things to consider:

*I graduated from a prestigious undergrad with a 3.9 GPA in the Social Sciences and a number of university-wide awards (including the Chancellor's Award for most outstanding senior in my class of 4,000 students). However, I managed not to take a single science or math course during my undergrad career - meaning my last "relevant" class was high school chemistry. I scraped through with an A but struggled mightily.
*I've always had a serious case of impostor syndrome and, after reading thousands of posts on SDN about students' experiences, I'm terrified that I would fail out of med school. Sometimes I pore over USMLE review guides and wonder how I could ever possibly master subjects like biochemistry. How would I be able to memorize hundreds of pathways, for example, when I have no idea what any of the words mean? I'm convinced I'll become overwhelmed by the sheer amount of material and drop out the first semester of classes.
*Going along with my last point, one of my biggest reservations is that I've never truly had to master/memorize a huge body of material for a class or exam and worry that I'm fundamentally incapable of doing so. Is this a skill that can be learned, even after years out of school? How the hell do people learn everything for the USMLE? I look at board review books and feel like I'd be overwhelmed by the amount of material on just a few pages. Is this a common fear for other prospective students?

I know nursing school isn't a cakewalk by any means, but it certainly seems less terrifying than the prospect of pursuing an MD. There's a direct-entry master's program at Boston College that allows you to become a Mental Health Nurse Practitioner in just two years - my friend did this program and went from having zero science background to working at an outpatient mental health clinic making $140k in two years, which is amazing to me. Beyond the money, he's able to do really meaningful work with underserved populations who really need it - something that's also really important to me.

So I guess my question is - what would you do in my situation?

Here's the thing: I have to take prereqs regardless of which path I pursue. However, those would look different for med school vs. nursing school. My friend who went to BC took the handful of prereqs they require at a community college online while working full-time. This would be ideal for me, but I know that med schools require prereqs to be taken at four-year universities, and so if I decide to go the MD route, I'll probably apply to post-bacc programs like Goucher, Agnes Scott, etc. If I do the MHNP route, on the other hand, there's no point in accruing a ton of debt if I can take the nursing school prereqs online while continuing to work full-time.

My other concern is my age. If I start a post-bacc program next fall, that puts me at finishing the prereqs and being able to start med/nursing school when I'm almost 30. Is it worth it to pursue the MD route if I won't be out of residency until I'm almost 40? The thought of being a full-fledged nurse practitioner soon after 30 is super appealing, obviously.

Besides the rigors of med school, my other concerns include salary, work-life balance, and the possibility that I'll always regret not going the MD route if I decide to pursue nursing.

Most of the Psychiatrist vs. Mental Health Nurse Practitioner threads on SDN end up devolving into arguments about how MHNPs are so much less knowledgeable and less qualified to treat people with mental health issues. I'm not really interested in that facet of this debate. Of course I'd want to provide the best possible care to my patients, but I don't need bitter diatribes about how underqualified MHNPs are. That's not going to be a deciding factor for me.

I don't really know what I'm hoping for by posting this. Maybe someone was/is in the same boat and has useful advice? Maybe someone has convincing arguments re: why going the MD route makes more sense for someone in my situation (or vice versa)? Maybe someone else struggled with a similarly debilitating fear of failure and can provide words of encouragement?

Thanks in advance, and sorry for the novel.

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[WisNeuro]

I'm having a lot of difficulty deciding whether I should pursue a career in Psychiatry (MD) or become a Mental Health Nurse Practitioner (MHNP).

Background: I'm 27 years old and have extensive background/publications in mental health research at various prestigious universities. I'd always planned to do a PhD in Psychology, but over the years I've realized I'd rather work primarily with patients in a clinical setting.
.

I know it's maybe besides the point of the question at hand, but the majority of us with clinical psychology PhDs actually do primarily work with patients in a clinical setting.

 

[DD214_DOC]

I'm having a lot of difficulty deciding whether I should pursue a career in Psychiatry (MD) or become a Mental Health Nurse Practitioner (MHNP).

Most of the Psychiatrist vs. Mental Health Nurse Practitioner threads on SDN end up devolving into arguments about how MHNPs are so much less knowledgeable and less qualified to treat people with mental health issues. I'm not really interested in that facet of this debate. Of course I'd want to provide the best possible care to my patients, but I don't need bitter MD students railing about how underqualified MHNPs are. That's not going to be a deciding factor for me.

You keep seeing the physician vs MHNP debate come up because there is truth in it. It's not at all, "bitter MD students". It's also those in clinical practice who have first-hand experience on the difference in ability and knowledge.

If you are truly interested in human behavior and mental health, I suggest you completely forget the MHNP route. Your best option would be psychiatry or clinical psychology, whether it's a PhD or PsyD program. I work alongside all other disciplines on a daily basis, and while I respect and collaborate/consult with psychologists frequently, I do wonder how often medical causes of psychological/psychiatric presentations are missed and never properly referred due to their lack of education, training, and experience in medicine.

 

[WisNeuro]

You keep seeing the physician vs MHNP debate come up because there is truth in it. It's not at all, "bitter MD students". It's also those in clinical practice who have first-hand experience on the difference in ability and knowledge.

If you are truly interested in human behavior and mental health, I suggest you completely forget the MHNP route. Your best option would be psychiatry or clinical psychology, whether it's a PhD or PsyD program. I work alongside all other disciplines on a daily basis, and while I respect and collaborate/consult with psychologists frequently, I do wonder how often medical causes of psychological/psychiatric presentations are missed and never properly referred due to their lack of education, training, and experience in medicine.

You'd be surprised how often this is missed by medical providers. I'd say in about 50% of my evals, I'm the one who is asking for providers to order lab tests to rule out likely medical causes for cognitive dysfunction.

 

[DD214_DOC]

You'd be surprised how often this is missed by medical providers. I'd say in about 50% of my evals, I'm the one who is asking for providers to order lab tests to rule out likely medical causes for cognitive dysfunction.

No, I'm not surprised. I see things missed by primary care all the time.

 

[Mad Jack]

I'm having a lot of difficulty deciding whether I should pursue a career in Psychiatry (MD) or become a Mental Health Nurse Practitioner (MHNP).

Background: I'm 27 years old and have extensive background/publications in mental health research at various prestigious universities. I'd always planned to do a PhD in Psychology, but over the years I've realized I'd rather work primarily with patients in a clinical setting.

Here are a few other things to consider:

*I graduated from a prestigious undergrad with a 3.9 GPA in the Social Sciences and a number of university-wide awards (including the Chancellor's Award for most outstanding senior in my class of 4,000 students). However, I managed not to take a single science or math course during my undergrad career - meaning my last "relevant" class was high school chemistry, which I struggled with mightily.
*I've always had a serious case of impostor syndrome and, after reading thousands of posts on SDN about students' experiences, I'm terrified that I would fail out of med school. Sometimes I pore over USMLE review guides and wonder how I could ever possibly master a subject like biochemistry. How could I memorize hundreds of pathways, for example, when I have no idea what any of the words mean? I'm convinced I'll become overwhelmed by the sheer amount of material and drop out within a few weeks.
*Going along with my last point, one of my biggest reservations is that I've never truly had to master/memorize a huge body of material for a class or exam and worry that I'm fundamentally incapable of doing so. Is this a skill that can be learned, even after years out of school? How the hell do people learn everything for the USMLE? I look at board review books and feel like I'd be overwhelmed by the amount of material on just a few pages. Is this a common fear for other prospective students?

I know nursing school isn't a cakewalk by any means, but it certainly seems less terrifying than the prospect of pursuing an MD. There's a direct-entry master's program at Boston College that allows you to become a Mental Health Nurse Practitioner in just two years - my friend did this program and went from having zero science background to working at an outpatient mental health clinic making $140k in two years, which is amazing to me. Beyond the money, he's able to do really meaningful work with underserved populations who really need it - something that's also really important to me.

So I guess my question is - what would you do in my situation?

Here's the thing: I have to take prereqs regardless of which path I pursue. However, those would look different for med school vs. nursing school. My friend who went to BC took the handful of prereqs they require at a community college online while working full-time. This would be ideal for me, but I know that med schools require prereqs to be taken at four-year universities, and so if I decide to go the MD route, I'll probably apply to post-bacc programs like Goucher, Agnes Scott, etc. If I do the MHNP route, on the other hand, there's no point in accruing a ton of debt if I can take the nursing school prereqs online while continuing to work full-time.

My other concern is my age. If I start a post-bacc program next fall, that puts me at finishing the prereqs and being able to start med/nursing school when I'm almost 30. Is it worth it to pursue the MD route if I won't be out of residency until I'm almost 40? The thought of being a full-fledged nurse practitioner soon after 30 is super appealing, obviously.

Besides the rigors of med school, my other concerns include salary, work-life balance, and the possibility that I'll always regret not going the MD route if I decide to pursue nursing.

Most of the Psychiatrist vs. Mental Health Nurse Practitioner threads on SDN end up devolving into arguments about how MHNPs are so much less knowledgeable and less qualified to treat people with mental health issues. I'm not really interested in that facet of this debate. Of course I'd want to provide the best possible care to my patients, but I don't need bitter MD students railing about how underqualified MHNPs are. That's not going to be a deciding factor for me.

I don't really know what I'm hoping for by posting this. Maybe someone was/is in the same boat and has useful advice? Maybe someone has convincing arguments re: why going the MD route makes more sense for someone in my situation (or vice versa)? Maybe someone else struggled with a similarly debilitating fear of failure and can provide words of encouragement?

Thanks in advance, and sorry for the novel.

If you're not concerned with being the best at what you do, go PMHNP.

 

[WisNeuro]

No, I'm not surprised. I see things missed by primary care all the time.

Not just primary care, they're only a small amount of my referrals.

 

[SmallBird]

I'm having a lot of difficulty deciding whether I should pursue a career in Psychiatry (MD) or become a Mental Health Nurse Practitioner (MHNP).

Background: I'm 27 years old and have extensive background/publications in mental health research at various prestigious universities. I'd always planned to do a PhD in Psychology, but over the years I've realized I'd rather work primarily with patients in a clinical setting.

Here are a few other things to consider:

*I graduated from a prestigious undergrad with a 3.9 GPA in the Social Sciences and a number of university-wide awards (including the Chancellor's Award for most outstanding senior in my class of 4,000 students). However, I managed not to take a single science or math course during my undergrad career - meaning my last "relevant" class was high school chemistry, which I struggled with mightily.
*I've always had a serious case of impostor syndrome and, after reading thousands of posts on SDN about students' experiences, I'm terrified that I would fail out of med school. Sometimes I pore over USMLE review guides and wonder how I could ever possibly master a subject like biochemistry. How could I memorize hundreds of pathways, for example, when I have no idea what any of the words mean? I'm convinced I'll become overwhelmed by the sheer amount of material and drop out within a few weeks.
*Going along with my last point, one of my biggest reservations is that I've never truly had to master/memorize a huge body of material for a class or exam and worry that I'm fundamentally incapable of doing so. Is this a skill that can be learned, even after years out of school? How the hell do people learn everything for the USMLE? I look at board review books and feel like I'd be overwhelmed by the amount of material on just a few pages. Is this a common fear for other prospective students?

I know nursing school isn't a cakewalk by any means, but it certainly seems less terrifying than the prospect of pursuing an MD. There's a direct-entry master's program at Boston College that allows you to become a Mental Health Nurse Practitioner in just two years - my friend did this program and went from having zero science background to working at an outpatient mental health clinic making $140k in two years, which is amazing to me. Beyond the money, he's able to do really meaningful work with underserved populations who really need it - something that's also really important to me.

So I guess my question is - what would you do in my situation?

Here's the thing: I have to take prereqs regardless of which path I pursue. However, those would look different for med school vs. nursing school. My friend who went to BC took the handful of prereqs they require at a community college online while working full-time. This would be ideal for me, but I know that med schools require prereqs to be taken at four-year universities, and so if I decide to go the MD route, I'll probably apply to post-bacc programs like Goucher, Agnes Scott, etc. If I do the MHNP route, on the other hand, there's no point in accruing a ton of debt if I can take the nursing school prereqs online while continuing to work full-time.

My other concern is my age. If I start a post-bacc program next fall, that puts me at finishing the prereqs and being able to start med/nursing school when I'm almost 30. Is it worth it to pursue the MD route if I won't be out of residency until I'm almost 40? The thought of being a full-fledged nurse practitioner soon after 30 is super appealing, obviously.

Besides the rigors of med school, my other concerns include salary, work-life balance, and the possibility that I'll always regret not going the MD route if I decide to pursue nursing.

Most of the Psychiatrist vs. Mental Health Nurse Practitioner threads on SDN end up devolving into arguments about how MHNPs are so much less knowledgeable and less qualified to treat people with mental health issues. I'm not really interested in that facet of this debate. Of course I'd want to provide the best possible care to my patients, but I don't need bitter MD students railing about how underqualified MHNPs are. That's not going to be a deciding factor for me.

I don't really know what I'm hoping for by posting this. Maybe someone was/is in the same boat and has useful advice? Maybe someone has convincing arguments re: why going the MD route makes more sense for someone in my situation (or vice versa)? Maybe someone else struggled with a similarly debilitating fear of failure and can provide words of encouragement?

Thanks in advance, and sorry for the novel.

The next ten years are going to be an important chunk of your life - if you pursue training as a MHNP, you will more quickly have a good salary and positive worklife balance. If Boston College is an option for you, you will get excellent training from my experience with people in and graduates of the program. There are many jobs in mental health (particularly in larger integrated care systems like the once we have in New England) that are really well suited to NP's where the task at hand is such that you can do as good a job as any (for example, the NP's that we have working in our psych ED are experienced and competent at the task of deciding who needs admission). The disadvantages are that in the longer term you could make twice as much being a psychiatrist, and the breadth of experience will allow you to be very skilled in a number of settings - the NP's I have worked with are great at what they do, but would need a good amount of time to become competent if they were to shift to a different setting like inpatient or CL, since so much of there learning happens in the first year or two of being an NP in practice. I do think that both can provide career satisfaction. Good luck!

 

[clausewitz2]

Not just primary care, they're only a small amount of my referrals.

Hardly surprising. Recognizing medical causes of psychiatric presentations is literally a core competency of psychiatrists; we are the specialists that are meant to be able to do that. It would be nice if it was better but modern medicine in practice is super-silo'd.

 

[WisNeuro]

Hardly surprising. Recognizing medical causes of psychiatric presentations is literally a core competency of psychiatrists; we are the specialists that are meant to be able to do that. It would be nice if it was better but modern medicine in practice is super-silo'd.

Well, the majority of my referrals are from psychiatry. Plenty of missed causes there. My point was more that we all seem blind to the shortcomings of our own profession, while being more than happy to point out others' shortcomings. Confirmation bias is a hell of a thing across healthcare.

 

[deleted736562]

Most of the Psychiatrist vs. Mental Health Nurse Practitioner threads on SDN end up devolving into arguments about how MHNPs are so much less knowledgeable and less qualified to treat people with mental health issues. I'm not really interested in that facet of this debate.

I guess if you're not interested into that you can go the MHNP route.

If you're interested in actually providing the best care to your patients and really knowing what you're doing there's really one route.

 

[tarheel919]

I know it's maybe besides the point of the question at hand, but the majority of us with clinical psychology PhDs actually do primarily work with patients in a clinical setting.

Right - that's why I wrote PhD in Psych, not Clinical Psych. Having worked in Psych research for 5 years, it seems like the vast majority of Psych PhDs don't focus exclusively on clinical work (and I was envisioning an academic career that combined research with patient work and teaching - something that no longer appeals to me whatsoever).

 

[WisNeuro]

Right - that's why I wrote PhD in Psych, not Clinical Psych. Having worked in Psych research for 5 years, it seems like the vast majority of Psych PhDs don't focus exclusively on clinical work (and I was envisioning an academic career that combined research with patient work and teaching - something that no longer appeals to me whatsoever).

I would imagine almost no general psych PhDs do patient care as they wouldn't be accredited to be licensed. Although, maybe as an LPC or midlevel kind of thing.

 

[tellmemore2020]

I am a 4th year medical student. I went through undergrad taking a bunch of introductory abnormal psychology and mental health classes, worked FT with psychiatric the population between college and med school, and aced a bunch of medical school exams that grilled me on psychiatry - diagnostics, psychopharm, the rules & the exceptions, the side effects. I am in my fourth year taking psychiatry electives and it is dawning on me that I know a pittance and that I will be spending MY LIFE learning this craft. I am excited to interview and pick the people who I think will best lay the foundation for my learning. They will hold me accountable on how I dissect journal articles, how I interview patients, how I watch for side effects, and how I call for help. I put myself in an excellent position to find the best people to do this. I knew all the downsides of this profession, and I agree they are significant, but the quality of my work is important to me and I picked this field to work in for the rest of my life, so I decided to go all in.

What do NP's do while all this learning is happening?
Watch from the sidelines.
See short visits. Meet billing thresholds. Make money for themselves, but also for their MD bosses, for the rest of their lives, while receiving training at the discretion of their bosses.

To me, this seemed "career lite." You decide whether it is or not and where career ranks on your priority list.

PS The only time I cried in K-12 was in AP chemistry class.

 

[tarheel919]

I am a 4th year medical student. I went through undergrad taking a bunch of introductory abnormal psychology and mental health classes, worked FT with psychiatric the population between college and med school, and aced a bunch of medical school exams that grilled me on psychiatry - diagnostics, psychopharm, the rules & the exceptions, the side effects. I am in my fourth year taking psychiatry electives and it is dawning on me that I know a pittance and that I will be spending MY LIFE learning this craft. I am excited to interview and pick the people who I think will best lay the foundation for my learning. They will hold me accountable on how I dissect journal articles, how I interview patients, how I watch for side effects, and how I call for help. I put myself in an excellent position to find the best people to do this. I knew all the downsides of this profession, and I agree they are significant, but the quality of my work is important to me and I picked this field to work in for the rest of my life, so I decided to go all in.

What do NP's do while all this learning is happening?
Watch from the sidelines.
See short visits. Meet billing thresholds. Make money for themselves, but also for their MD bosses, for the rest of their lives, while receiving training at the discretion of their bosses.

To me, this seemed "career lite." You decide whether it is or not and where career ranks on your priority list.

PS The only time I cried in K-12 was in AP chemistry class.

This definitely gives me a lot to think about. Thanks for sharing!

 

[Maggie Martin]

If there is a program for MNHP that lasts a total of two years. You would have no life those two years. Even if you can take many classes online, you would still have clinicals. Besides that, it sounds like your saying the whole master's degree take two years. This means you would be expected to earn an LPN, RN, BSN, and then your master's all in two years. This is either a scam or just a bad idea all around. source: have nurses in the family.

 

[Mad Jack]

If there is a program for MNHP that lasts a total of two years. You would have no life those two years. Even if you can take many classes online, you would still have clinicals. Besides that, it sounds like your saying the whole master's degree take two years. This means you would be expected to earn an LPN, RN, BSN, and then your master's all in two years. This is either a scam or just a bad idea all around. source: have nurses in the family.

The whole degree is likely 3 years- one year accelerated BSN and two years of MSN. They're pretty hectic programs. Columbia has one, as does Yale and several other great schools. You never bed to get a LPN to be a RN, they're entirely different qualifications with entirely separate accrediting bodies. Fun fact, ASN programs also have their own accrediting body, so nurses have turf wars and qualification fights with themselves all the time.

 

[Maggie Martin]

The whole degree is likely 3 years- one year accelerated BSN and two years of MSN. They're pretty hectic programs. Columbia has one, as does Yale and several other great schools. You never bed to get a LPN to be a RN, they're entirely different qualifications with entirely separate accrediting bodies. Fun fact, ASN programs also have their own accrediting body, so nurses have turf wars and qualification fights with themselves all the time.

As I've known nurse who gotten their LPN on their way to RN. I'm a bit sceptical.

 

[Mad Jack]

As I've known nurse who gotten their LPN on their way to RN. I'm a bit sceptical.

You can do that, but it's stupid to do so, as many LPN credits don't transfer and the LPN degree is nearly worthless in many states. RNs generally just go straight to the ASN or BSN route, depending on whether they start at community college or a university.

 

[Maggie Martin]

You can do that, but it's stupid to do so, as many LPN credits don't transfer and the LPN degree is nearly worthless in many states. RNs generally just go straight to the ASN or BSN route, depending on whether they start at community college or a university.

Oh, well I knew that. I think the program my sibling went to gave your LPN, but somehow the LPN year also acted like the first year of your RN.

 

[precisiongraphic]

@tarheel919 Regardless of your final decision, if you want to do this you're looking at at least two years, maybe three, of prerequisites for either RN or MD/DO admittance. My suggestion is to shadow both a psychiatrist and an PMHNP (MHNP is not a very common abbreviation) while you're waiting and look at courses needed to get you to each goal.

Look at prerequisites for both paths and line up similarities. You can start taking prerequisites without knowing your final goal. For example, a rough outline of MD/DO science requirements/MCAT prereqs (not all are the same this is in general) are:
One year biology> microbiology > anatomy/physiology
One year general chem > One year Ochem > Biochem
One year physics
Calculus and/or statistics

Nursing prereqs vary but most of them want at least the following:
One year of bio> microbiology> anatomy/physiology
One or two semesters of general chem
One semester of physics or intro to physics
Statistics


Some ABSN programs require O-Chem (UMich and Boston College) as do some BSN/MSN combo programs.

The point is that you could start taking bio, chem and then depending on how well you do, decide to go for MD/DO or decide a quicker path to an NP is better. Or you may decide that you can't live without the rigor of an MD/DO and go for broke as a psychiatrist and not be limited by NP. One other thing - only a few med schools won't take community college prereqs. Some med schools discourage CC credits (Duke, Johns Hopkins) but look at a few target schools and make your decision. Or maybe take physics, bio and chem at CC and transfer to a four-year university for Ochem and Biochem.

If you haven't taken science classes since high school ~10 years ago and
if you struggled in HS Chem, you may not be able to do well enough in the required classes to get into an MD/DO school or even to get into the very competitive Accelerated BSN (ABSN) or even Direct Entry BSN/MSN programs which take people with high undergrad GPAs and GRE scores. HOWEVER, you have a history of achievement and I've worked with many adults whose early HS/undergrad achievement was way below what they can attain as a motivated adult. And be advised, there is some incorrect info above from people unfamiliar with nursing programs entry requirements.

If you decide on NP, it can be pretty quick (but don't go to an LPN program). With your prior education, you could aim for a BSN, an ABSN or BSN/MSN combo. Or you could get an ADN degree and then go somewhere with a ADN to MSN program like Vanderbilt. Also, there are two-year BSN/MSN programs - not all are three years, again Vanderbilt is an example.

Good luck in your journey.

 

[PikminOC]

You'd be surprised how often this is missed by medical providers. I'd say in about 50% of my evals, I'm the one who is asking for providers to order lab tests to rule out likely medical causes for cognitive dysfunction.

I see this more with people who take insurance and are under severe time constraints

 

[PikminOC]

The nps route you can treat 6 yo and above. I would need a child fellowship to do this.

 

[ExcaliburPrime1]

In your shoes, I'd stick with the PhD in Psychology route. For either track you mention, you'd need to do two years worth of undergraduate prerequisites. If high school chemistry was difficult, then you may not fair well in this endeavor, and in any case that's time not spent in your final career or making money.

I'd say that if you had an intense passion for either route to go for it, as you're still not old (had plenty of older colleagues in medical school) by any means. Given the information you posted, however, I'd stick to PhD in Psychology.

And as was mentioned early on, plenty of Psychology PhDs do clinical work, particularly (in my limited experience) in the VA setting.

 

[PlasticBag]

I'm a 3rd year medical student now who was in your shoes a few years ago. I was conviced I wanted to do a PhD in Clinical Psychology, barely passed high school chemistry, and didn't take any science classes until the post-bac. Here are some thoughts for you:

1) yes, you can learn medicine, even if you don't have an aptidude for science. Having said that, it won't be easy. I didn't really know how to study for physics or organic chemistry and didn't enjoy any of the prerequisite classes. I did well enough to be accepted to medical school but the process was riddled with self doubt and uncertainty. First year of medical school felt like a constant teetering on the edge but again, I passed all my classes. Sometime in the second year I finally learned how to study better, things started making more sense, and I even did above average on boards. My sanity though, ouch.

2) the fact that you're wondering about potential regrets if you don't pursue medical school makes me think you should start thinking more long term. Where do you see yourself in ten, fifteen years? Because now, as a 3rd year med student, I can tell you I get excited when I get to do an injection ("real medicine you guys!") but it will get old in a few weeks probably. You might be happy with your nursing degree initially, because things will be new and you'll help people, but ask yourself if you can be satisfied with that work in fifteen years. Even though you will get more experience and can certainly move up, you will always be limited compared to a psychiatrist.

3) finally, if you think you might not be satisfied long-term with not having the highest level of training, I echo the poster above and would say that a PhD in clinical psychology is worth your consideration. Getting accepted to a program is not easy but might be less painful for you than taking science prerequisites and jumping through a million other med school related hoops. As a psychologist, you will truly be an expert in your field. You will have much more potential for growth, can attain higher positions, etc etc. Many psychologists do exclusively clinical work so don't worry about being stuck in academia. You can even do a PsyD if you want to focus on clinical work only.

Good luck!

 

[WisNeuro]

I see this more with people who take insurance and are under severe time constraints

I don't notice a big difference. Saw it plenty in the VA, where insurance isn't an issue. See it about the same now in a non-profit institution.

 

[PikminOC]

In my practice now, I have much more time to get to the root of the issues. When I worked at nonprofits and at the va, I felt too much time constraints (4 pts in an hour) to do so. Just my experience. N of 1

 

[tarheel919]

I'm a 3rd year medical student now who was in your shoes a few years ago. I was conviced I wanted to do a PhD in Clinical Psychology, barely passed high school chemistry, and didn't take any science classes until the post-bac. Here are some thoughts for you:

1) yes, you can learn medicine, even if you don't have an aptidude for science. Having said that, it won't be easy. I didn't really know how to study for physics or organic chemistry and didn't enjoy any of the prerequisite classes. I did well enough to be accepted to medical school but the process was riddled with self doubt and uncertainty. First year of medical school felt like a constant teetering on the edge but again, I passed all my classes. Sometime in the second year I finally learned how to study better, things started making more sense, and I even did above average on boards. My sanity though, ouch.

2) the fact that you're wondering about potential regrets if you don't pursue medical school makes me think you should start thinking more long term. Where do you see yourself in ten, fifteen years? Because now, as a 3rd year med student, I can tell you I get excited when I get to do an injection ("real medicine you guys!") but it will get old in a few weeks probably. You might be happy with your nursing degree initially, because things will be new and you'll help people, but ask yourself if you can be satisfied with that work in fifteen years. Even though you will get more experience and can certainly move up, you will always be limited compared to a psychiatrist.

3) finally, if you think you might not be satisfied long-term with not having the highest level of training, I echo the poster above and would say that a PhD in clinical psychology is worth your consideration. Getting accepted to a program is not easy but might be less painful for you than taking science prerequisites and jumping through a million other med school related hoops. As a psychologist, you will truly be an expert in your field. You will have much more potential for growth, can attain higher positions, etc etc. Many psychologists do exclusively clinical work so don't worry about being stuck in academia. You can even do a PsyD if you want to focus on clinical work only.

Good luck!

Thank you so much for the thoughtful feedback.

 

[splik]

Hardly surprising. Recognizing medical causes of psychiatric presentations is literally a core competency of psychiatrists; we are the specialists that are meant to be able to do that. It would be nice if it was better but modern medicine in practice is super-silo'd.

If its a core competency then the vast majority of psychiatrists are incompetent. Most psychiatrists over investigate when it is blindingly obvious that the patient has a primary psychiatric disorder and underinvestigate or do a hatchet job of a workup the rest of the time. In particularly MRI and NMDA-R Abs seem to over ordered by idiots to "rule out" something. That's not medicine, its anarchy. From what I can tell most psychiatrists havent even heard of the conditions that most bear resemblance to primary psychiatric disorder, let alone able to detect them

 

[PikminOC]

If its a core competency then the vast majority of psychiatrists are incompetent. Most psychiatrists over investigate when it is blindingly obvious that the patient has a primary psychiatric disorder and underinvestigate or do a hatchet job of a workup the rest of the time. In particularly MRI and NMDA-R Abs seem to over ordered by idiots to "rule out" something. That's not medicine, its anarchy. From what I can tell most psychiatrists havent even heard of the conditions that most bear resemblance to primary psychiatric disorder, let alone able to detect them

So imagine what its like to be a person with less rigorous training, less years of training, less standardized training, less exams, ....

And I have never ordered those things. Are you referring to academic types?

 

[deleted736562]

If its a core competency then the vast majority of psychiatrists are incompetent. Most psychiatrists over investigate when it is blindingly obvious that the patient has a primary psychiatric disorder and underinvestigate or do a hatchet job of a workup the rest of the time. In particularly MRI and NMDA-R Abs seem to over ordered by idiots to "rule out" something. That's not medicine, its anarchy. From what I can tell most psychiatrists havent even heard of the conditions that most bear resemblance to primary psychiatric disorder, let alone able to detect them

Which speaks even further to the deficiencies in the NP training. As a psychiatrist in training, I feel I don't get enough training in both the medical nuances as well as psychotherapeutic aspects. So even those 8+4 years aren't really enough.

I don't think anyone should be practising psychiatry without the medical training necessary to tell what is medically significant and what is not. And, as a side note, the psychology interns who rotate at our hospital openly struggle with differentiating delirium from chronic psychosis (which is fine, as their area of expertise is somewhere else).

 

[WisNeuro]

Which speaks even further to the deficiencies in the NP training. As a psychiatrist in training, I feel I don't get enough training in both the medical nuances as well as psychotherapeutic aspects. So even those 8+4 years aren't really enough.

I don't think anyone should be practising psychiatry without the medical training necessary to tell what is medically significant and what is not. And, as a side note, the psychology interns who rotate at our hospital openly struggle with differentiating delirium from chronic psychosis (which is fine, as their area of expertise is somewhere else).

I'd say many residents, mostly IM, struggle with delirium. I've gotten many consults for testing, or a competency/capacity evaluation to find a patient with delirium, so I boot the consult and ask them to take care of that first. Psychiatry is usually pretty good with that, they mostly struggle with malingering and somatoform patients in my referral queue.

 

[EarlyCareerAcademicPsych]

Hi tarheel919,

Based on what you wrote, I think that you'll do great no matter what. I can say more about my positive reaction to your post, if you want, but I'll move on to your request - what would I do if I were in your shoes (an exercise which requires me to take the information that you've given and imagine what it would be like for you but still be me a bit, too).

That's a tough call. I don't actually think that I can do that. But I can tell you a bit about my position at this point and let you know my thoughts about your dilemma based on my vantage point.

I'm a staff psychiatrist at a VA medical center and a residency associate program director at a tertiary care academic medical center. I most love doing psychotherapy, in particular group therapy, and clinical education. I did college in four years straight out of high school; deferred acceptance to medical school for a year to travel and work outside the US; did med school in six years as I got interested in research along the way; and completed a general psychiatry residency in 2008. I took my VA job right out of residency and I have worked there full-time since. I started the APD job four years ago. I did no fellowships after residency but I have pursued additional training in psychotherapy (individual and group). I think that my job is (almost) perfect right now but it has taken a lot of effort on my part to get it here.

Here are my thoughts about your situation:
-- In your post, you identified your goal (completing a training program which will allow you to work clinically with patients seeking mental health treatment); two specific options to get to your goal (pre-bacc + med school + psych residency vs. night classes + master's program); some of the pros/cons of each option (timeline, debt, other factors); and some things that you know about yourself in school.

-- I didn't hear much detail about what prompts you to want to do this work, apart from the fact that you have always thought that you would get a PhD in psychology and that you have done research in the field. I get curious about that. You may have already done this but I recommend that you consider the following: you haven't actually done the job yet. So you have an idea about what it is. What do you imagine that you will like about the work?

-- I recommend that you also consider what kind of professional formation that you are seeking. Doctors and nurses have different basic ways of doing and being in clinical settings. IMO, this relates to the history of those who came before us and the way that the professions are set-up. Think about clinicians that you have met - who shares your particular values more often? In the work setting, who do you want to become like? Because you will be impacted by your professional training in ways that are hard to anticipate or even describe until after the process has happened.

Remember: you can make the "wrong" choice and it can still all work out just fine.

Good luck!

 

[psychnpgirl]

hello!

Okay, I want to contribute to this thread, although maybe you've already made a decision.

I can relate to you. I did the PMHNP route right out of college (got a BSN in nursing after HS with the intention of becoming a psych NP). I too have always had serious imposter syndrome and just believed I would never be able to go to medical school because my strengths are not math/science.

Now I'm in month 3 of practicing as a psych NP and the demand is insane which is great (I had one job offer literally for 150k for 40 hours a week) but also I just wish I had more training. And, it still profits over the course of a 30 year career to become a psychiatrist rather than NP, since the could get offers for 300k in a similar organization.

I don't know. that's just my experience. If I were starting over, I probably would have tried to go to medical school, I was just intimated by how many others were trying to go and thought I would fail completely, plus I wasn't sure I wanted to provide care to patients forever.

That being said, I'm sort of thinking of attempting to go to medical school or a PhD in nursing or opening a practice.

 

[MNurse2MD]

Im in a similar situation, however, I am trying to go to Medical School. I graduated with a Bachelors of Science in Psychiatric Nursing and am now interested in going to med school to purse an MD with the hopeful possibility of obtaining a Psychiatry Residency. If your grades are good and you are competitive, then go for the MD route. Your interests may also change over the course of you MD education as well, so its best to keep your options open.

Lets put this into easier terms to understand. Nursing school is four years full time, your grades have to be great and competitive to purse masters education, which is another 2 years fulltime. So all in all, you will spend about 1 year trying to get into nursing school, 4 years fulltime for a nursing degree, you need at least 2 years experience before pursing a nurse practitioner masters as well as 2 years fulltime for the designation: 1+4+2+2=9 years. MD: 4 years, plus residency which is either 4 or 5 years = 8-9 years for psychiatrist, no to mention you start receiving a salary during residency.

Its ultimately what you want to do; carative vs curative.

 

[st2205]

So all in all, you will spend about 1 year trying to get into nursing school, 4 years fulltime for a nursing degree, you need at least 2 years experience before pursing a nurse practitioner masters as well as 2 years fulltime for the designation: 1+4+2+2=9 years. MD: 4 years, plus residency which is either 4 or 5 years = 8-9 years for psychiatrist, no to mention you start receiving a salary during residency.

I wouldn’t say that’s very accurate. While you’re counting the year trying to get in to nursing school (an undergrad program), you’re assuming direct entry into medical school. A lot of programs are taking people fresh out of nursing school. The discouraging part I remember in my intern year was thinking I could have already been making good money as an NP for 2-3 years already.

 

[SourceOfDenial]

Without reading this thread at all, the answer is don't do either and become a nurse anesthetist.

 

[DXM1]

Become a physician.

 

[boogaaloo]

Yeah, no one respects an NP. People respect a nurse, and people respect a doctor. But NPs don't get no respect.

 

[Horners]

Bumping this to see if anyone else would like to weigh in!

Only a Med student interested in psych, but I can think of a pros and cons list:

MD - pros
- more education
- more training
- many more doors are open to you (academia, consulting, etc...)
- more recognition in the field as an expert (not to say you won’t be great clinically in either field, specifically talking about recognition)
- Possibly overall increased lifetime earnings

Cons:
- 8 year time minimum commitment
- accrue ~200k in debt
- possibly less overall lifetime earnings

PMHNP list is essentially opposite of that one.

I think the money is really variable depending on what you end up doing in either field.

If you are research driven and want to be an expert, it’s the MD no doubt.

If you care more about your current lifestyle and are being very pragmatic about things it’s the PMHNP.

Ask yourself what’s important to you and ask yourself which cons you can you live more with.

Whatever you do, just dedicate yourself to being the best you can be for your patients.

Good luck


Sent from my iPhone using SDN mobile

 

[Merely]

You'd be surprised how often this is missed by medical providers. I'd say in about 50% of my evals, I'm the one who is asking for providers to order lab tests to rule out likely medical causes for cognitive dysfunction.

If it’s missed by medical providers then it’s probably going to be missed by non medical providers. Unless you’re saying psychologists are superior to psychiatrists in detecting medical causes of psychiatric illness?

 

[WisNeuro]

If it’s missed by medical providers then it’s probably going to be missed by non medical providers. Unless you’re saying psychologists are superior to psychiatrists in detecting medical causes of psychiatric illness?

Holy necrobump, Batman! And, in some contexts, yes, we are better. Depends on the context because we look for different things. IME, psychiatrists are generally not great at picking up on certain neurological things, and are downright terrible at picking up on malingering of neurological deficits. Now, most medical providers across the spectrum are as well. But, this is what I do day in and day out, so it's all on my differential from the get go.

 

[857770]

Physician Assistant is another option. There are PA residencies in the field of psychiatry that one can do. Here is one example: Physician Assistant (PA) in Psychiatry Fellowship | Department of Psychiatry

 

[heartsink]

Bumping this to see if anyone else would like to weigh in!

I'm just in the middle of my first cycle of applications and interviews for medical school right now, but maybe I can add a perspective for you or anyone else googling up this thread in the future.

I was in a very similar place as you described about 4 years ago, when I was 24 and two years out from undergrad. I had plans for clinical psychology and made it as far as interviewing for PhD programs when I did a 180 and decided on psychiatry instead.

Starting from nothing -- with no clinical experience, no volunteering, none of the undergrad science classes completed, and then studying for and taking the MCAT -- it took me over 4 years of course correction from my first physics class in winter quarter of 2014 until summer of 2018 just to apply with an application worth considering. I'll spare you the lengthy story but can PM anyone who really wants it.

The take-away is that life as a working adult trying to go toward medicine and starting from scratch can be tricky, long, drawn out and unexpected delays can happen all the time for any reason.

Personally, if I don't get into medical school on my first try, i'll be in my 30's when I start, and I've come to terms with that possibility, and accepted it. I have not spent the last 4 years of my life changing my entire future to change plans again now, but I caution any other would-be non-traditional pre-med student to consider strongly why they want to pursue medicine and how many years of course-correction is unacceptable to them.

As an aside, I would also say that while very few medical schools outright preclude CC science classes, if you have already graduated from a 4-year university then it may look suspect to go to a CC for your science pre-reqs.

And regarding psychiatrist vs psych NP or the like, I would echo what has already been stated here in that you should not expect to have the same level of mastery should you choose NP, but the decision between the two circles back to the question of why pursue either.

 

[tarheel919]

Bumping this to see if anyone else would like to weigh in!

 

[WisNeuro]

 

[Crayola227]

oh, cool, there's another horse to beat! I was wondering where it went!

 

[WisNeuro]

oh, cool, there's another horse to beat! I was wondering where it went!

SDN is a veritable dude ranch of dead horses.

 

[ridethecliche]

Bumping this to see if anyone else would like to weigh in!

Do you actually have any other questions to ask? You know.... like anything insightful to show that you've actually read the thread and done some homework over the last year and a half to merit anyone taking their time to help you?

 

[tarheel919]

Do you actually have any other questions to ask? You know.... like anything insightful to show that you've actually read the thread and done some homework over the last year and a half to merit anyone taking their time to help you?

Why do I need to justify to you whether this thread merits your attention? If you don't want to engage, don't.