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Pterion
So I finished my psych rotation in December. I was really looking forward to it for a number of reasons. I have no plans to become a psychiatrist, despite my doctorate in psychology (PsyD) and six years in the field. I really wanted to know how it looked from the inside. I finally got my chance.
Like every experience I have, this is NOT representative. N=1. Also, as some of you may know, one's experience on rotations (or even practica for that matter) vary widely with the members of the team. I'll try to spare you complaints regarding the scutwork, since this is consistent across all schools and all specialties. There is nothing for it. You just do it, get through it and don't let it crush your spirit.
First observation: I met exactly zero psychiatrists who had anything but full respect for psychologists. Each had experience working with psychologists and found that - like any profession - the good ones made themselves known. When they found out I was a psychologist, they were quite excited to engage me in the diagnostic process during intake, or the treatment modification process for inpatients. The interns (first year residents) often asked my opinion of different issues during the rotation. This was a collaborative and enjoyable part of the process for me. It added a ton of practical medical information to my understanding of mental illness. In fact, one doc described his job as "to first rule out all possible medical causes of alterations in mental status and functioning". To be fair, not everyone agrees with that role description. But it was food for thought.
Second observation: as you may imagine, there was near-universal opposition to RxP. Far from venomous, these folk seemed puzzled by why psychologists would seem to want to walk away from all the good they actually already contribute to health care. This mirrors posts on this topic that I have submitted in the past. A long time ago I posted a quote by a neurologist who posited that psychologists wanted RxP because "they realized that therapy was essentially placebo and wanted to be able to do some real good". I didn't see that sentiment shared in the psychiatry department. Although I didn't hear any direct arguments regarding competition, I can't imagine this hasn't been considered.
Third: My home program has a very strong curriculum for training in psychotherapy. Not as much as I had in a PsyD program, but easily as much as the university based PhD program. Frankly, I saw no advantage to any of the three curricula. In fact, the psychotherapy faculty was largely the same among the three programs. The few psychiatrists I personally worked with were extremely well-read and informed. All become CBT certified and have the opportunity to learn psychoanalysis, IPT, or psychodynamic a la Allan Schore, Paul Wachtel et al. I am thus quite uncomfortable assuming without thorough background information on each individual that any of the three degrees are necessarily better-trained as therapists. As others have pointed out, experience counts for a lot.
Fourth: the group I worked with extremely pragmatic financially. Once a month grand rounds focused on practice management issues. One that I attended broke down the three major 3rd party payors in this area, the reimbursement schedule for each billable action and the projected productivity needed for 5-6 different desired income levels. NEVER saw anything like that in grad school. One speaker openly discouraged psychotherapy as an income-generating practice. "Put in your pro-bono hours," she advised. You all know the why.
That's all I have the energy for. This was not intended as a flame to or against anyone. This is just my experience. I hope it made some sense - I'm on labor and deliver night call right now, so I'm approaching 20 hours of sleep total for the last 6 days. I'll post more if there's interest. Over and out.
Like every experience I have, this is NOT representative. N=1. Also, as some of you may know, one's experience on rotations (or even practica for that matter) vary widely with the members of the team. I'll try to spare you complaints regarding the scutwork, since this is consistent across all schools and all specialties. There is nothing for it. You just do it, get through it and don't let it crush your spirit.
First observation: I met exactly zero psychiatrists who had anything but full respect for psychologists. Each had experience working with psychologists and found that - like any profession - the good ones made themselves known. When they found out I was a psychologist, they were quite excited to engage me in the diagnostic process during intake, or the treatment modification process for inpatients. The interns (first year residents) often asked my opinion of different issues during the rotation. This was a collaborative and enjoyable part of the process for me. It added a ton of practical medical information to my understanding of mental illness. In fact, one doc described his job as "to first rule out all possible medical causes of alterations in mental status and functioning". To be fair, not everyone agrees with that role description. But it was food for thought.
Second observation: as you may imagine, there was near-universal opposition to RxP. Far from venomous, these folk seemed puzzled by why psychologists would seem to want to walk away from all the good they actually already contribute to health care. This mirrors posts on this topic that I have submitted in the past. A long time ago I posted a quote by a neurologist who posited that psychologists wanted RxP because "they realized that therapy was essentially placebo and wanted to be able to do some real good". I didn't see that sentiment shared in the psychiatry department. Although I didn't hear any direct arguments regarding competition, I can't imagine this hasn't been considered.
Third: My home program has a very strong curriculum for training in psychotherapy. Not as much as I had in a PsyD program, but easily as much as the university based PhD program. Frankly, I saw no advantage to any of the three curricula. In fact, the psychotherapy faculty was largely the same among the three programs. The few psychiatrists I personally worked with were extremely well-read and informed. All become CBT certified and have the opportunity to learn psychoanalysis, IPT, or psychodynamic a la Allan Schore, Paul Wachtel et al. I am thus quite uncomfortable assuming without thorough background information on each individual that any of the three degrees are necessarily better-trained as therapists. As others have pointed out, experience counts for a lot.
Fourth: the group I worked with extremely pragmatic financially. Once a month grand rounds focused on practice management issues. One that I attended broke down the three major 3rd party payors in this area, the reimbursement schedule for each billable action and the projected productivity needed for 5-6 different desired income levels. NEVER saw anything like that in grad school. One speaker openly discouraged psychotherapy as an income-generating practice. "Put in your pro-bono hours," she advised. You all know the why.
That's all I have the energy for. This was not intended as a flame to or against anyone. This is just my experience. I hope it made some sense - I'm on labor and deliver night call right now, so I'm approaching 20 hours of sleep total for the last 6 days. I'll post more if there's interest. Over and out.
