Psychology or Psychiatry career?

[Blue084]

I have a question for any psychiatrist about what the exact difference is between psychology and psychiatry? I already know that psychologists don't go to medical school and can't prescribe medicine like psychiatrists, but other than that what is the difference? I'm interested in the human brain, memory and mental disorders but i've always considered myself as a social science student and I am slightly interested in natural science (namely biology) but I hate labs (plus I'm bad with algebra).

Therefore I was thinking that psychology might be the best for me but it seems like psychiatrists get paid twice as much and have a very large reputation that psychologists aren't near to having so i'm confused on what I should pick. If I really thought Psychiatry was worth it I would consider taking math and natural science labs to ensure myself a spot in medical school but I haven't seen any evidence that Psychiatry is all that better than Psychology (please don't take offense to this I am simply trying to figure out the differences).

If Psychiatrists can get an undergrad in anything aslong as they have science & math prereqs and the first couple of years of medical school are broad learning about medicine then when do Psychiatrists actually learn about the human mind, mental functions, etc...? I know Psychologists normally spend more than four years learning about those things.

Also is it true that most medical schools are so competitive that if you don't have a 3.5 they probably won't give you an interview? I only have a 3.3 (thanks largely in part to math) so I was curious.

Lots of quesitons I know but please reply if you know, thanks.

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[mdblue]

I have a question for any psychiatrist about what the exact difference is between psychology and psychiatry? I already know that psychologists don't go to medical school and can't prescribe medicine like psychiatrists, but other than that what is the difference? I'm interested in the human brain, memory and mental disorders but i've always considered myself as a social science student and I am slightly interested in natural science (namely biology) but I hate labs (plus I'm bad with algebra).

Therefore I was thinking that psychology might be the best for me but it seems like psychiatrists get paid twice as much and have a very large reputation that psychologists aren't near to having so i'm confused on what I should pick. If I really thought Psychiatry was worth it I would consider taking math and natural science labs to ensure myself a spot in medical school but I haven't seen any evidence that Psychiatry is all that better than Psychology (please don't take offense to this I am simply trying to figure out the differences).

If Psychiatrists can get an undergrad in anything aslong as they have science & math prereqs and the first couple of years of medical school are broad learning about medicine then when do Psychiatrists actually learn about the human mind, mental functions, etc...? I know Psychologists normally spend more than four years learning about those things.

Also is it true that most medical schools are so competitive that if you don't have a 3.5 they probably won't give you an interview? I only have a 3.3 (thanks largely in part to math) so I was curious.

Lots of quesitons I know but please reply if you know, thanks.

1. psychiatrists do a 4-yr residency after their med school (specialty training)which trains them to deal w/ "mental functions" and lot more.
2. mind and brain dichotomy does not exist. Also brain is a component of the human body. HENCE you can't study it in isolation.
3.undergrad curricula/perf does not typically correlate w/ med-school performance(but the MCAT does )
Hope this helps

 

[Blue084]

3.undergrad curricula/perf does not typically correlate w/ med-school performance(but the MCAT does )
Hope this helps

So do you think that if I have a 3.3 and get a good score on the MCAT then I should have a good chance? I am only in my second year of undergrad and I think I should be able to raise my GPA up to at least a 3.4 and i'm sure i'll do well in my science courses. I just want to make sure I have a chance because according to UofM their average entering GPA is 3.7

I'm up for the challenge as long as I have a chance at getting in.

 

[rpkall]

If you are interested enough in the hard sciences, and interested in having a medical foundation for your future understanding of psychology and its treatment options, I think psychiatry is a very nice choice. If you are interested in the study of the physiology of psychological disorders, clinical assessment, and academic study, there are some excellent Neuropsychology PhD programs out there (BU has a good one, I believe, in Boston). If you are interested primarily in social science research on behavior, analysis, and therapy, or in providing therapy, then there's the PhD in clinical psychology. If you have less desire to research, and more desire to stick to clinical practice only, the PsyD is an option that has a more clinical (not research) focus.

There's a really good book by the APA on graduate programs in psychology. You should check it out. There are a loooooooooooooot of options. There are places to be if you hate math, love math, can't talk to people, love people, hate people, enjoy research, hate research, like physiology, hate physiology, enjoy handing people tissues, etc. And any combination of those.

I think optimally you want to find the program best suited to what you want from your professional life. Ask yourself: do you have a desire to teach, do you want to provide therapy services, do you want to do research, do you want to work as part of multidisciplinary team with defined roles/responsibilities, do you want to prescribe medicine, what are you looking to make ($$$)? Psychiatrists make the most money when you compare the average clinical provider across modalities, but there might be more to being happy and fulfilled than money. Who knows.

 

[john182]

I have a question for any psychiatrist about what the exact difference is between psychology and psychiatry? I already know that psychologists don't go to medical school and can't prescribe medicine like psychiatrists, but other than that what is the difference? I'm interested in the human brain, memory and mental disorders but i've always considered myself as a social science student and I am slightly interested in natural science (namely biology) but I hate labs (plus I'm bad with algebra).

Therefore I was thinking that psychology might be the best for me but it seems like psychiatrists get paid twice as much and have a very large reputation that psychologists aren't near to having so i'm confused on what I should pick. If I really thought Psychiatry was worth it I would consider taking math and natural science labs to ensure myself a spot in medical school but I haven't seen any evidence that Psychiatry is all that better than Psychology (please don't take offense to this I am simply trying to figure out the differences).

If Psychiatrists can get an undergrad in anything aslong as they have science & math prereqs and the first couple of years of medical school are broad learning about medicine then when do Psychiatrists actually learn about the human mind, mental functions, etc...? I know Psychologists normally spend more than four years learning about those things.

Also is it true that most medical schools are so competitive that if you don't have a 3.5 they probably won't give you an interview? I only have a 3.3 (thanks largely in part to math) so I was curious.

Lots of quesitons I know but please reply if you know, thanks.

Mental illness can be both "psychological" where there is not basis in physical findings and also when there are bases in physical findings. Psychology is training initially in "what is normal" whereas psychiatry is "this is a colon and this is the cancer that killed the guy". Psychiatrists first study physical systems like any physician and finalise in a protracted study on the link between physical and neurological signs and symptoms and the behaviour. Often this includes psychology to some degree but not always.

E.g., schizophrenia has a large genetic basis which a lab geneticist has little interest in studying the psychopathology of the psychotic, the psychiatrist straddles that division by studying teh genetic basis and it's application to the beahviour, symptoms and treatment.

E.g., bipolar has been studied for millenia, becoming more formalised in the past 200 years to help treatment (I suppose the thinking being that a civilised society should help the less fortunate). Mood stabilisers help - and the basis is very dependent on a working knowledge of psychopharmacology. Yes, the internal medicine specialist might also know lots of psychopharmacology but has he interviewed and assessed enough patients with mania to recognise the unique symptoms every patient presents? Or the elderly with the UTI and agitation but who gets passed to psych? My experience tells me that the internal medicine specialist doesn't even have the time to interview, not even for 10 mins not to mind the 1-1.5 hours for initial assessment only, not to mind discover is it a biological or sociological precipitent to the patient spending all their money on a poppy farm in Venezuela and inviting the whole town to dinner while listening to God on the stereo.

I suppose the root cause of mental illness as above shows that it's not as simple yet as simply a quick blood test like a U/E to dx. dehydration or an MRI to show contusions or a tumour, or vascular lesions contributing also to e.g., dementia, delirium and so on.

E.g., the anxiety or phobia? Well if we can barely get physical origins to the "big" bread and butter mental illness like schizophrenia which now has very firm genetic and environmental risk factors (in only past decade really) and e.g., BPAD with fMRI which is hideously expensive then it's going to be a while before we move on from palpitations and SOB when looking for physical (read: neurological) origins for phobias and such. This is where the psychologist comes in, to explore further the difficult origins (for example) and whether even finding these at all would help (not necessarily) and furthermore how to treat.



I hope this helps. Four last points:
1. Don't dismiss psychiatry simply because treatment options are limited
2. Don't dismiss psychiatry simply because insurance companies prefer a quick procedure and then dishcarge people when they have received "health service" - people are not cars
3. The Psychiatrist has the unique perspective of studying and undertsanding and treating behaviour as the mind obviously cannot exist in isolation - the brain is in there two, and as the past 2-3 decades have shown, it is even more so the basis for mental illness. The neurologist doesn't study how to interview and put patient's who are for example hallucination at ease - that takes skill and without it the patient might never admit and could harm themselves or others. This is the role of the psychiatrist - to undertsand the neurology and neuroanatomy (as the knowledge is advanced especially over the next decade), the psychology, the psychopathology and the psychopharmacology.
4. Psychologists are primarily academic at advanced pHD level, whereas the psychiatrist will have spent much much more time with *patients*, yes *patients*, the *sick people*. You'll interview a patient and family a 4am in A/E for an hour, the psychologist won't because the psychiatrist must decide on whether this is more purely neurological/internal e.g., delirium or is more purely psychological e.g., anxiety at home and family tensions or is it that very very very broad area in between and the area that is as yet largely unexplored, this is where the mind meets the brain, and there is the psychiatrist.

* you can't compress medical school into a postgrad course - it gives you a perspective and understanding that the psychologist will lack and thus not be able to understand fully why mental illness is not just "magical" in the air, but exists in firm physical basis, and the research by psychiatrists, pharmacologists and geneticists and neurologists alike all have been showing over recent years that more and more mental illness including the classics have attributable physical origins. But then, some people maintained the earth was flat and bacteria couldn't exist. There is a mountain of genetic and pharmacological and neurological research being done on mental illness. No psychologist can involve himself there even if given Royal High Decree of Being Ultra Lord Over The Universe by Bush himself, so the prescribing thing is no problem. And show me the neurologist or lab pharmacologist who gives the time of day to an acutely psychotic patient and continue to assess them?

Some day, if the US actually gave a **** about mentally ill people, maybe crime would drop, people would stay in school longer and advance themselves personally. But it's unlikely as crime is good political credit, drop outs tend to purchase more luxury goods and people who decide to become artists don't function well in a 2 week holiday a year hamster-in-the-wheel US-style working life.

Yes, I am in Europe.

 

[50960]

Yes he needs LiCo3.....

 

[Anasazi23]

Yes he needs LiCo3.....

Not necessarily...very much depends on the presenting nature of the bipolar (and of course comorbid medical conditions).



I too found that blog to be riddled with what are, ironically, misconceptions about psychiatric misconceptions. Depakote, Lithium and its uses, and the concept of SSRIs causing switching are very real clinical phenomena, and it appears as thought the blog writer has a bit to learn about practicalities of psychiatric practice. Another example was the risperdal-hyperprolactinemia comments. (It's not unreasonable to look at growth patterns when dealing with prolactin dysfunctions. Also, a medical doctor shouldn't be overly concerned in that population with this over-touted side effect. Correlate the lab results, which are often artificially inflated with your knowledge of the endocrine function of your patient. i.e. don't treat the lab value.)

 

[PsychMD]

John, if you don't mind my asking...did you finish your training here and then left to practice in Europe, or are you still in training or in a fellowship in Europe at this time? Did you graduate from an EU Med school?

I've been racking my brains to find opportunities to practice for a while in Europe, as a locums, and I thought initially that a Boarded Psych. MD might have a better chance than any other US specialists (esp. as a temp. or locums), however it seems that the licensing procedures for US docs are basically so complicated or even impossible (at the specialist level), that I gave up after a while. I know there are some shortcuts for going locums with the NHS in the UK, but I don't think I found anything else beyond this...and, frankly, the idea of NHS is not too appealing...It also doesn't sound that the concept of locums is too developed in the EU at this time.

Thanks a bunch for any pointers...you can PM me, if you want.

Great post, BTW!

 

[Allotheria]

"Psychologists are primarily academic at advanced pHD level, whereas the psychiatrist will have spent much much more time with *patients*, yes *patients*, the *sick people*. You'll interview a patient and family a 4am in A/E for an hour, the psychologist won't because the psychiatrist must decide on whether this is more purely neurological/internal e.g., delirium or is more purely psychological e.g., anxiety at home and family tensions"


John, that isn't actually true.

 

[Anasazi23]

John, that isn't actually true.

I think the point that John was making was that psychiatrists, much more than PhDs, spend time in hospitals and routinely work 10+ hours or even 2 days at a time if on-call (I've done it multiple times, as has most psychiatry residents). Multiply that times a 4 year residency, and that's a lot of patient hours on average, especially when comparing that to PhDs, many of whom are primarily academic in nature, and if they even see patients routinely, see them for much longer periods of time on average. Even a purely clinical PhD psychologist spends an inordinate longer time period with each patient, thus seeing less total patients . Further, many psychologists don't do their own testing, thus seeing even less. Even if you consider seeing one patient for 5 hours the same as 10 patients in that time period as far as "spending time with patients," psychiatrists are not bogged down with hours of report writing (althought they have their own paperwork problems).

This isn't better or worse, just different, based on the nature of the work.

 

[Anasazi23]

It is interesting that you give the short amount of time that a psychiatrist spends with a patient as a possible advanatage. Yes, they will see more patients that way, with potentially limited depth of understanding..."

I didn't say it was an advantage, I addressed the original quote of "spending time with patients, as evidenced by: "Even if you consider seeing one patient for 5 hours the same as 10 patients in that time period as far as 'spending time with patients.'"

I could make a similar comment regarding the "limited depth of understanding" snippit. You state that physicins don't even speciallize until residency, which is true. They are busy with 2 years of clinical coursework, and 2 additional years of clinical rotations and some additional classes. Then then undergo 4 additional years of residency. While I'm sure you meant to imply that spending more time with each patient allows you to know more about them, I wouldn't necessarily call it "limited understanding," considering they bring a very comprehensive and important knowledge base to their medical/psychiatric assessment of the patient.

For what it's worth, you won't convince me that graduate school, which mixes clinical exposure with classes the first year or two (in some institutions), is more difficult or allows more patient exposure than the 6 years of clinical exposure obtained through medical school and residency, NOT including fellowship. I very much agree with your last paragraph, and as such we can agree to agree that they serve completely different purposes, which is why psychiatrists feel insulted that their medical school curriculum can be hammered into a 2 year post-grad course without any medical school level clinical rotations, and expect to have a similar knowledge base.

Peace....

 

[PublicHealth]

I think psychology has a lot more variation in salary level than psychiatry. There is certainly the potential to make substantially less, but, for example, the mean salary for neuropsychologists is about $127,000. It really comes down to, in my opinion, what you want to do.

Reference?

 

[Allotheria]

Anasazi23
…For what it's worth, you won't convince me that graduate school, which mixes clinical exposure with classes the first year or two (in some institutions), is more difficult or allows more patient exposure than the 6 years of clinical exposure obtained through medical school and residency, NOT including fellowship.

I can understand this…. But you have to remember that psychology, as a discipline, is just as diverse as medicine is. I have to disagree to your argument. I'm a Clinical Health Psychologist. That means that I had to take medical classes in addition to my normal graduate psychology classes, and from being in both settings (Med and Grad) psychologists get a lot more clinical exposure (grad 5yrs vs Med 2-3 pre-residency/internship). I'm not sure how other schools are, but this was just how mine was structured.


Anasazi23
…psychiatrists, much more than PhDs, spend time in hospitals and routinely work 10+ hours or even 2 days at a time if on-call (I've done it multiple times, as has most psychiatry residents).

I have to disagree with this as well. I have worked 24+hr shifts in the ER, and I've been on call CL for shifts at a time. I think again that it just depends on how the hospital is structured.

 

[Anasazi23]

"...allows more patient exposure than the 6 years of clinical exposure obtained through medical school and residency"

How much of that clinical experience is even relevent? It isn't in psychiatry. Inefficient.

I understand your point. But to say that any clinical exposure is not relevant is what makes the difference between a physician and a psychologist. What you see as not relevent and inefficient will hurt or kill patients when you don't pick up or differentially diagnose a masquerading medical condition. This isn't lip service. I see it.

You also said, "I also don't support psychiatrists assessing mental illness or conducting psychotherapy." I just hope that was a typo because it makes absolutely no sense. Psychiatrists were conducting therapy before psychologists, and many pride themselves on their training, analytic or otherwise. I can't imagine what would happen to you if you said that in my residency program. I agree, of course, that psychologists are the most proficient in administering and interpreting psychological tests. However, I really don't many (any) physicians chomping at the bit to administer these tests.

 

[Anasazi23]

I can understand this…. But you have to remember that psychology, as a discipline, is just as diverse as medicine is. I have to disagree to your argument. I'm a Clinical Health Psychologist. That means that I had to take medical classes in addition to my normal graduate psychology classes, and from being in both settings (Med and Grad) psychologists get a lot more clinical exposure (grad 5yrs vs Med 2-3 pre-residency/internship). I'm not sure how other schools are, but this was just how mine was structured.

I won't comment on you taking the same courses as med students. Suffice it to say that the courseload is different, to say the least. I can't imagine you stayed up late studying for your renal pathology exam and 5 other courses, with lab, whilst doing your psychology classes. Your point about the clinical exposure stops prematurely. Residents get the 2+ years of undergrad medical clinical rotations (4 years of clinical exposure in some med schools), then 4 YEARS of residency. Not only this, but please understand the general differences between the typical psychotherapy or testing patient and the medical patient or acutely psychotic/sick psychiatric patient. There are differences that I'm sure you're aware of.

..I have worked 24+hr shifts in the ER, and I've been on call CL for shifts at a time. I think again that it just depends on how the hospital is structured.

Yes, but please don't try to compare the workload of a medical resident to that of even a health psychologist. The responsibilities are different, the knowledge bases are different, the problems are much different. I recommend that the psychologists read some of the threads here on SDN. Spend a few hours reading the general residency forum, the osteopathic and allopathic forums, the clincial rotation forums, the ER forums, surgery forums. You might be surprised at what you see and the intensity of it all.

 

[Anasazi23]

Paendrag, it's hard to believe the amount of ignorance you have about the medical profession in general and the training of psychiatrists in particular.

Not to harp on this, but the statement you keep making about PhD training being all "germane" while implying that psychiatrists' training through the medical model is a waste of time because every second isn't spent learning how to sit a patient in front of a Vigil K or CPT is asinine. And what exactly is "germane to training?" To a medical doctor, it is all germane. If you can't see the relationships, then it's not the fault of the physician or medical model. You'd get your butt handed to you and would be routinely and thoroughly embarrassed on a regular basis regarding your knowledge base if you came to my residency program spewing the praises of your knowledge like this.

You're not a hero because you recommend to stop Topamax in a confused patient. You said you wouldn't believe how many times you've recommended to stop it. I can believe a lot. 100? 5000? How many times? As for the multiple medications and your experience in not needing them, I tell you that you probably have no idea what 4/5 of those medications are, how they work, how they affect the patient, and why they're on them to begin with.

You then state that you'd be surprised if an MD had as much knowledge as you in eeg, etc. What is the point of this comment? Likewise, I wouldn't be surprised if the average medical doctor knew infinitely more than you about every single other aspect of medicine that wasn't your specialty. I find it curious as to why you didn't mention neurologists or neuropsychiatrists or even well-trained psychiatrists in that comment.

Amazingly, you go on to state that you don't think psychiatrists can make diagnoses because of "limited training to inform clinical opinions." Again, this only attests to the severely limited understanding you have of medical school and residency training. I still find it hard to believe that you actually feel this way. Nevertheless, it is unreasonable and impractical to think that every inpatient and outpatient psychiatric patient can sit for hours of testing to arrive at what you describe as formulations about nondescript areas of functioning. Don't be a slave to your diagnostic tests. The clinical interview, not an often confabulated and corrupted result of a paper-and-pencil test, are what diagnoses patients. The use of K scores and other validity measures help somewhat, but in no way replace knowledge garnered through the clinical interview and through collateral information. If you begin to think that every needed aspect of diagnosis comes from a pencil and paper test, then you have even less psychiatric knowledge than you know. There are so many more factors, many to most of which are not measured by these tests or at least not admitted to. I recommend you read "Brain Calipers," or some other type of book like this, to see the values in classic descriptive psychiatry garnered throught the interview and mental status exam. You'll be surprised at the subtlties that psychiatrists are trained to pick up and incorporate in their diagnosis and more importantly, their TREATMENT.

 

[Anasazi23]

I think psychology has a lot more variation in salary level than psychiatry. There is certainly the potential to make substantially less, but, for example, the mean salary for neuropsychologists is about $127,000. It really comes down to, in my opinion, what you want to do.

Not according to this.

The study is, of course, from 2003. Unless the mean jumped almost $30,000 in two years. That's quite a projection. I'd like to meet the guy who claims he makes $980,000. . . ridiculous.

 

[edieb]

Here is an excellent article relevant to the topic!

Turning The Table: A Paradoxical Approach to Prescription Authority

Submitted by Foad Afshar, Psy. D.
I wonder if psychiatrists, who are most adamantly opposed to psychologists being able to have prescriptive authority, would engage in a bit of a hypothetical match as follows. Would they acknowledge that psychiatric training does not provide them with sufficient (or at least as extensive) training in psychotherapy as psychologists have? Would they also recognize that most psychiatrists do not engage in a sustained psychotherapeutic activity with their patients? If these elements are true, would psychiatrists either limit their scope of practice to medication management only, and agree not to provide psychotherapy? Or, would they subject themselves to the credentialing standards of mental health boards in order to receive a separate authority to provide psychotherapy?

What outrage among the medical community would we cause if we proposed regulations that would severely limit the option of practicing psychotherapy for psychiatrists? Do you think even those psychiatrists who never practice psychotherapy, nor ever intend to, will join a vigorous opposition against any such bill? Why should such a proposal cause an uproar? After all, if only a few of them provide psychotherapy, why should they care that they lose their ability to provide psychotherapy, and if they are confident about their skills, why should they mind being subjected to higher standards for psychotherapy practice as psychologists do?

The reader will no doubt quickly recognize the paradoxical approach to the issue taken by these questions. Indeed, psychiatrists and ARNPs, would call the above postulate preposterous. They would, no doubt, fight any attempt to limit their scope of practice, and even those of them who have no intentions of providing psychotherapy will ban together in a unified voice to dispel any attempt to limit the scope of psychiatric practice in general. They recognize, correctly, that the freedom to practice the full scope of psychiatric services is essential to all of them even if only a few of them enter the realm of psychotherapy.

So too should all psychologists join the effort to bring to the community of professional psychology the freedom and authority to provide a full spectrum of mental health services. Whether only a few choose to delve into the prescription realm of service delivery is irrelevant to the issue. The progressive and continuous erosions the boundaries of who provides psychological services, and insurance companies increasing striving to find "cheaper" alternatives in mental health service delivery puts the profession of clinical psychology at a dangerous intersection in history. The scope of practice for psychologists needs to be expanded. Gaining prescriptive authority is a critical step for psychologists in regaining their appropriate place in the mental health service delivery system. This effort is not about just some psychologists gaining the ability to write prescriptions, it is about all clients having the option to use the most qualified providers to treat them fully. Let us learn from our opponents and join together to defend the right of our colleagues to practice what we know best regardless of our own personal preferences for practice.

Dr. Afshar practices in Concord, NH.

Not according to this.

The study is, of course, from 2003. Unless the mean jumped almost $30,000 in two years. That's quite a projection. I'd like to meet the guy who claims he makes $980,000. . . ridiculous.

 

[john182]

1) Illustrating that many psychologists do have training in incorporating and considering general medical conditions

Sure, and part of my training is reading lots of psychology books, but it sure doesn't make me a psychologist, or is the converse only the one you find true? Psychiatrists study all about Piaget, Erikson, Mahler etc., . Doesn't make them experts, eh? Likewise, looking up a drug is what a lot of patients do and likewise without formal training and examination is the basic medical and clinical application of body sciences, it is much *much* more likely to be misunderstood (e.g., if I read a PhD physics book, I'm sure likewise).

Basically, the life or death situation you illustrate is not usually a primary concern for psychiatry anymore than it is for psychology.

I find that to be absolutely hilarious after coming from hospital having assessed a suicidal patient. The actuality of whether a situation *is* life or death is a core part of the psychiatrists training; the shere number volume of patients means you learn to see the "real" intent in DSP/DSH from the rest. This is important and a decision to be made clinically on every aspect of the patient's physiology and the degree to which the have affected themselves. Involuntary admission on a bad decision can implicate the entire future life and paper tests or scans aren't going to show it - time with as many patients as possible does.

example, my point with that is that many of the problems that patients have are iatrogenic.

Many is like how long is a piece of string. Show me a complete audit of all reasons for referrals and the solution you provided. If most of that is iatrogenic, why in blue hell haven't you referred them back saying you are not a physician and for some doctor to clear up the meds? Or do you spend most time saying "I have the answer! Stop your tablets!" !!?!

They both have very good texts out and I've enjoyed attending lectures and rounds they have done. I don't particulary respect the average psychiatrist that slaps a "hysteria" diagnosis on someone with an acquired orbitofrontal lesion with no prior behavioral dysregulation, or whatever.

I don't think a diagnosis of hysteria is ever slapped as it's so rare that it would take many months if not years to come to that conclusion. I would suggest that an "acquired orbitofrontal lesion" that has been diagnosed would be better off with a neurologist or old-age psychiatrist. I would sincerely doubt such an example you mentioned was ever actually real. A confirmed CT/MRI abnormality would never ever be diagnosed as hysteria.

I think many psychiatrists overly rely on analytic theory. There very little empirical support for that. Those who don't (i.e., pill pushers), do not spend enough time to form a reliable and valid opinion.

Again with the "many". Stop it, it's meaningless. Back it up or stop it.

 

[john182]

Here is an excellent article relevant to the topic!

So too should all psychologists join the effort to bring to the community of professional psychology the freedom and authority to provide a full spectrum of mental health services. Whether only a few choose to delve into the prescription realm of service delivery is irrelevant to the issue. The progressive and continuous erosions the boundaries of who provides psychological services, and insurance companies increasing striving to find "cheaper" alternatives in mental health service delivery puts the profession of clinical psychology at a dangerous intersection in history. The scope of practice for psychologists needs to be expanded. Gaining prescriptive authority is a critical step for psychologists in regaining their appropriate place in the mental health service delivery system. This effort is not about just some psychologists gaining the ability to write prescriptions, it is about all clients having the option to use the most qualified providers to treat them fully. Let us learn from our opponents and join together to defend the right of our colleagues to practice what we know best regardless of our own personal preferences for practice.

Dr. Afshar practices in Concord, NH.

I see no problem with such an argument, except it polarises an issue that is not actualyl polarisable. Typically my readings of US interpretations of situations come down to the "with us or against us", two choices, etc., .

It's like this: regularly, the depressed patient, for example, will also have physical/biological symptoms. The psychologist prescribes SSRIs left right and centre of course, but has the psychologist learnt how to do a neurological exam, even abasic physical exam? Listened to lungs? Interpret the MSU in an agitated elderly patient? Knows how Multiple Sclerosis vs. Subacute Combined Spinal Cord Degeneration affects the reflexes and as such how much of the depressive symptoms are psycho or motor ******ation or both?

The answer is they don't, and it's dangerous to presume that it's all about drugs. Psychiatrists exist because they are trained traditional doctors in the above aspects (as an example) and also with a specialist understanding of the biological (NOT JUST DRUGS), psychological (NOT JUST PSYCHOTHERAPY) and social (SEEMS TO BE IGNORED IN US PSYCHIATRY!!!).

The issue has been succesfuly polarised to drugs vs. no drugs. Much like Bush or No Bush. It's easily digestible, becomes the standard and totally misses the point. The only reason that psychologists want to rpescribe is because it will increase their salaries and the insurance companies like this because it reduces payments to psychiatrists. The patient feels good as they get their paroxetine or fluoxetine without having to see a doctor but that niggling abdominal pain is still there and gee whizz that psychologist was so sharply dressed but he never examined me, never tested by reflexes, never checked my cranial nerves and I have that double vision again. **** it, I'll go to the Family Practitioner. Next day, **** he doesn't know much about psychotropic drugs and here we go again but hang on now I am at the psychiatrist.

Yes indeedy, psychologists with a prescription pad is great. Another middleman in helping the mentally ill? I don't know, but it will sure make them a lot of money.

And yes, you can learn off by heart how to do a neuro exam. It's all over the net; but until you actually see sick people with the problems and how it affects them and then how it affects their mental health, you will still be a psychologist with a prescription pad. It will sell lots of drugs and pharma will make loads. Congratulations corporate america for finally purchasing the American Psychological Association!

Psychiatrists can train formally in psychotherapy, as can social workers, etc., . Anyone can, psychotherapy isn't "owned" by psychology any more than pharmaceuticals are "owned" by psychiatrists. Psychiatry as I have mentioned innumerably now, is not just "medication management", it's a broader understanding of the physical and mental. If family practioners can't get it right with prescribing, why would a non-physician with a pharma diploma? Psychiatry is like today when a patient referred for depression and anxiety who has been on paroxetine for 9 years comes in and she has frontal signs (very very mild but there) and hx. of absense-like attacks with aura and olfactory hallucinations and has untreated hypothyroidism. I leave the meds, refer for CT Brain and EEG. Welcome to psychiatry. A prescription pad will not help. So the prescribing psychologist doesn't recognise the physical manifestations of hypothyroidism? Doesn't know about epilepsy? What are you going to do, prescribe fúcking Prozac?

 

[Anasazi23]

Sorry, I should have been more specific. I was referring to private practice. If you look at the chart in the article you linked, the average for private practice is $120,000. There are some big earners in neuropsychology. The reason is forensics.

The standard deviation is over $70,000! How the hell do you interpret that? Especially when you have schmucks claiming they make almost half a mill in the sample.

 

[Anasazi23]

Basically, the life or death situation you illustrate is not usually a primary concern for psychiatry anymore than it is for psychology.

Tell that to the NMS patient I treated in the ICU last week. I didn't see any psychologists running to start the Dantroline.

Actually, when I get a case, if I don't know the medication, I look it up. That still doesn't address the fly by the seat of the pants medicine involved in dealing with a patient on 17 medications. Relative to my topamax example, my point with that is that many of the problems that patients have are iatrogenic.

You have not gone to medical school, don't assume you know more than medical doctors about treating medical patients. It will make you look very bad. You're not the first to come up with the idea that some illnesses are iatrogenic. It's part of the business.

Lancing a wart is germane to training? I do see the relationships. I know peripheral illness affects central nervous system performance and vice versa.

It is relevant...because it gives the doctor yet more exposure to surgical techniques, which patients will ask you about, and that they incorporate in their perception of your knowledge base. How do you know it's a wart? Can you differentially diagnose a drug-induced rash? Please don't say you can because I've seen dermatologists have trouble with the same on occasion.

I actually agree with you. I don't rely on paper and pencil tests primarily. Clinical interview and behavioral neuro tests are often more informative. But you have to know what you are looking for.

Absolutely wrong. In medicine we have "incidental findings." Look up the concept. I don't know what I'm looking for at 3am when my beeper goes off to evaluate a man literally barking in the ER who's threatening to kill either himself or the medical staff. Making informed decisions with often little data is difficult, but part of being a physician.

Also, even with that there are ways to go about things. Within what I do, I respect behavioral neurologists like Ken Heilman and Marcel Mesulam. They both have very good texts out and I've enjoyed attending lectures and rounds they have done. I don't particulary respect the average psychiatrist that slaps a "hysteria" diagnosis on someone with an acquired orbitofrontal lesion with no prior behavioral dysregulation, or whatever.

For every example you come up with of individual scenarios like this one, I can name 5 where untreated psychosis or bipolar vis a vis psychologist providing therapy delayed critical treatment and often caused a tragic event to unfold.

I think many psychiatrists overly rely on analytic theory. There is very little empirical support for that. Those who don't (i.e., pill pushers), do not spend enough time to form a reliable and valid opinion.

I'd be careful about ostracizing your psychologist colleagues who adore analytic theory; many still adhere to it. Many more, I'd venture than psychiatrists, who are often much more biologically based.

You're not going to convince anyone but yourself that psychologists make better medical doctors, than medical doctors do.

 

[Anasazi23]

Here is an excellent article relevant to the topic!

Turning The Table: A Paradoxical Approach to Prescription Authority

Submitted by Foad Afshar, Psy. D.
I wonder if psychiatrists, who are most adamantly opposed to psychologists being able to have prescriptive authority, would engage in a bit of a hypothetical match as follows. Would they acknowledge that psychiatric training does not provide them with sufficient (or at least as extensive) training in psychotherapy as psychologists have? Would they also recognize that most psychiatrists do not engage in a sustained psychotherapeutic activity with their patients? If these elements are true...

But they're not true. And for some reason, psychologists can't seem to understand that you get therapy training throughout the four years of psychiatry residency. During your first year in many institutions, you get therapy patients that you carry throughout the length of your training. You take classes in CBT, DBT, psychodynamics, family therapy, etc. Some of these programs emphasize it less or more, but it a core part of the curriculum. It would be unreasonable to assume that the practice of perfect therapy is as immediately important to human physiology and wellness as perfect practicing of medicine. Further, many psychiatrists DO provide therapy at 40-50min sessions daily. I can name lots. Sorry.

The premise that psychiatrists should not provide therapy is counterintuitive to the nature of practicing medicine in general. Some would argue that even during "med checks" some therapy takes place in some fashion.
[/QUOTE]

Calling psychiatry the "opponents" and asserting that psychology is the most comprehensive mental health care not only erodes any comraderie that the two professions share, but again shows a very short-sighted and limited understanding of health care in general.

 

[daelroy]

Anasazi23

I’m a Clinical Health Psychologist. That means that I had to take medical classes in addition to my normal graduate psychology classes

Were these true medical classes that were offerred in a medical school in which you sat in with a class full of medical students and took the same exams? Or were these "medical" classes. Because I too have taken "medical" classes on the graduate school level and they were not close to the same in regards to depth and difficulty as the ones in medical school

I have to disagree with this as well. I have worked 24+hr shifts in the ER, and I’ve been on call CL for shifts at a time. I think again that it just depends on how the hospital is structured.

Working a 24 hour shifts in an ER is not the same as working a 24 hour shift in a psych ward. In the ER, you are most likely sitting and doing nothing until you get consulted for the rare psych patient.

 

[daelroy]

Paendrag

Learn to use the quote functions and bold -

It makes reading your posts a lot easier.

 

[50960]

I don't know about that. I think most traditionally trained Ph.D. psychologists that do therapy tend to lean towards CBT and social learning theory. Those that remain enamored with analytic, interpersonal, and other non-research based approaches I don't really relate well to.

Also, Freud was biologically grounded, at least in his beliefs about his theory. Karl Pribram published an interesting article a while back on the "Neuropsychology of Sigmund Freud."

OK...sigh..who is bigger??

 

[Allotheria]

Were these true medical classes that were offerred in a medical school in which you sat in with a class full of medical students and took the same exams? Or were these "medical" classes. Because I too have taken "medical" classes on the graduate school level and they were not close to the same in regards to depth and difficulty as the ones in medical school.

My classes were true medical classes. Actually they were some of the most difficult classes that I have ever had. I had to learn a completely new way of studying for the exams. While the classes were rewarding I ultimately didn't enjoy being just a number out of a large lecture class. Of course the labs were smaller than the huge 120 student lecture, but I was spoiled by graduate school and the 1:1 attention/mentor relationship that you get in a PhD program. I do have to admit that it was quite intimidating my graduate class of 6 walking into a room of 120 med students and them wondering why the hell we were there.

Working a 24 hour shifts in an ER is not the same as working a 24 hour shift in a psych ward. In the ER, you are most likely sitting and doing nothing until you get consulted for the rare psych patient

LOL, that is so true. I've never gone more than 16 hours on the inpatient psych unit. I did win quite a few games of solitaire in the ER, but in defense of the ER when it gets busy it gets busy. There's nothing like having a back up of 8 psych patients and ER docs and charge nurses freaking out trying to clear up some beds for "real patients".

I won't comment on you taking the same courses as med students. Suffice it to say that the courseload is different, to say the least. I can't imagine you stayed up late studying for your renal pathology exam and 5 other courses, with lab, whilst doing your psychology classes. Your point about the clinical exposure stops prematurely. Residents get the 2+ years of undergrad medical clinical rotations (4 years of clinical exposure in some med schools), then 4 YEARS of residency. Not only this, but please understand the general differences between the typical psychotherapy or testing patient and the medical patient or acutely psychotic/sick psychiatric patient. There are differences that I'm sure you're aware of..

Actually my course load wasn't different. My class was expected to perform the same as the medical students in the class. As I said earlier I have an extreme amount of respect for MD's because those were some of the most challenging classes that I have ever had, and some of the most rewarding too. You're right though, I didn't stay up late studying renal pathology I mostly stayed up studying cognitive therapy theory and implementation and behavioral therapy, oh and statistics too. (Which I hated) I said in my post PRE-RESIDENCY. Psychologists get 5 years experience with psych pre-residency and MD's according to your post get a rotation and 2+ years clinical. Then they get 4 years clinical exposure.

This sounds like all the PhDs I know. They got clinical experience undergrad (2yrs) then in grad school (5yrs) and then post-grad (2yrs). Just like you stated for MDs (2yr, 4yrs, 4yrs). 9 years and 10 years… that is an extreme amount of time. You're not trying to make this who's got a bigger umm… amount of supervision are you ;o) Oddly enough I never understood this whole training argument. I mean psychologists get 30+ years residency after they graduate from a program and so do psychiatrists, both have to maintain CEU's, right?

I absolutely agree that there is a massive difference between a medical and a psych patient. I just don't understand your point, are you referring to the difference between the clinical exposure that psychologists and psychiatrists have? I apologize, I haven't had my coffee this morning and I'm just avoiding paperwork till my first client arrives

Yes, but please don't try to compare the workload of a medical resident to that of even a health psychologist. The responsibilities are different, the knowledge bases are different, the problems are much different. I recommend that the psychologists read some of the threads here on SDN. Spend a few hours reading the general residency forum, the osteopathic and allopathic forums, the clincial rotation forums, the ER forums, surgery forums. You might be surprised at what you see and the intensity of it all

Ok, I'm going to have to go with a WHOA cowboy to your comment about comparing the workload of medical residents to health psychologists. Who do you think I play solitaire with in the ER? In all seriousness though you are correct. The responsibilities are extremely different, and over lunch we discuss a lot of the stress and frustrations involved in our professions. Although please don't compare the workload of residents with that of psychologists because the professions are indeed so different. Alas, we both have to put up with the same amount of bureaucratic filibustering though, and we both love it when the med reps come and supply us with free lunches/dinners. Man I love it when they stop by. They always bring such wonderful treats.

 

[john182]

Placebo effects are often just as powerful (or nearly) and don't have the horrible side effects like making you fat (olanzopine). Also, therapy definitely impacts physiology. I think therapy should be the first resort in most psych cases (e.g., ADHD).

Mate, that sounds like you are on crack. A minority of patients on olanzapine suffer weight gain and the drug itself doesn't "make them fat", it's too much junk food from increased appetite. Lilly have a good course for patients on diet. To think that placeba is as powerful (or nearly) as olanzapine in an acutely psychotic person is just lunacy. Again, back that up. I've never seen such a preposterous statement.

If it was, it would likely be due to inappropriate prescribing - which undoubtedly is going to become rampant in the future as a lot of medical doctors do not understand psychopharmacology to a high degree, so adding non-medical doctors to the prescribing mix again simply serves to allow license and prescrption priveleges based on money, not research.

Placebo or antipsychotic? For christ's sake.

What is "most psych cases". What is a psych case? Is it the personality disorders (maybe they are prescribed olanzapine freely where you live)? The scope is so broad that saying "most psych cases" is like saying that bipolar is due to demonic possession and treatment is exorcism +/- psychotherapy.

More and more evidence and treatment for major psychiatric illnesses are being show to have that firm basis in reality. The mind doesn't exist without the body and brain. Psychology is from a time when treatment was a course of leeches so of course it is relevant, but as the science catches up with psychiatry, the psychologists worry they will be left behind? Isn't the issue really not that psychiatrists don't want to play, but that psychologists want the big blue ball or otherwise they'll cry.

 

[john182]

Oh, I understand that Olanzapine is an effective anti-psychotic. It is also just as effective as lithium in bipolar patients. I didn't mean to imply that a placebo was preferable in a psychotic patient. What percentage of mental health patients are psychotic?

You know, it's common enough these days for "research" to be done on drugs to find new treatment avenues to expand service bases - e.g., sertraline and anxiety, quetiapine and mood stabilisation. This is for developing a broader consumer base. A drug comes out, it's great (Olanzapine). Then BMS say we have Aripiprazole coming out shortly, the research says it's good, a new step form simply D2 blockade and so Lilly say, **** we need to get this prescribed more for something else.

What are the odds Aripiprazole will have a BPAD license in 5 years? I would be very surprised if it didn't, or at least BMS didn't try to get it.

Btw, my understanding is that Olazapine is more effective when there is weight gain (seems a bit of a catch-22).

I don't know where you'd get that idea. As the weight gain takes several months and Olanzapine can work within a fe short days (indeed, it is very effective in acute presentations) it would be unrelated? I'd be interested to see a study showing what you said above. Also, by "effective" do you mean "more antipsychotic"? There would be no pharmadynamical reason for that, besides increase VoD.

The body doesn't exist without the environment either. I have no problems with the medical model.

And the medical model *is* the only model. Perhaps in the past when little evidence of right sides vs left sided ventricular enlargement and basal ganglia change were not able to be seen the "medical model" was in dispute (e.g., in the 1960s and the pop-psychology revolution) but heck, open up any BJPsych or AJPsych and the biological basis for disease grows constantly. Therefore, the *only* model is the *medical model*. Unless you would prefer a series of theoretical questionnaires on isolated symptoms while excluding the entire of the patient's physiology because as a non-medical doctor you have only that way of practicing?

I think a good example of an area where there is not enough done with behavioral therapies/environmental manipulation is ADHD.



What's, "more and more?" What is a "major psychiatric illness?" Do I really have to look up epidemiological research on incidence and prevalence to discuss these issues with you?

Heh, I think you have that backwards.

No no, I think I wrote it unclearly. My statement was basicallly to imply that the evolution of modern psychology took place when investigations such as MRI and CT were decades off and the "lunatics" were that way because of a whole range of theories, from demonic possession, to well anything at all really - noone knew. From there, it was the medical doctors who ventured to diagnose and treat these people as traditionally the medical doctor comes first and the area of interest followed. We all started as medics learning anatomy, etc., so as one of the oldest professions that *why* psychiatry is medical and so is health (mental or physical). The *only* people trained in both are psychiatrists. to train in physical health you need a medical degree. To train in mental health you can do psychiatry or psychology or whatever, but only psychiatry gives you the expertise to straddle the disciplines.

 

[50960]

John, you really have your history wrong! Psychology evolved as a science to attempt to measure what medicine was trying treat as well as many other areas of human cognition and behavior. The field of psychology put the evidence-based idea into psychiatry before there were drug reps around to tell you what that phrase means.

Look it up...

 

[Allotheria]

John, you really have your history wrong! Psychology evolved as a science to attempt to measure what medicine was trying treat as well as many other areas of human cognition and behavior. The field of psychology put the evidence-based idea into psychiatry before there were drug reps around to tell you what that phrase means.

Look it up...

I am afraid that I have to agree with this statement. Although I think it was somewhat more collaborative than one field going it alone. I've always viewed psychology as psychiatry's science. I engaged in a wonderful debate with a bio chem researcher the other day about how physicians are not scientists. I was arguing that it depends where as his point was that unless they have formal research training they're not. I have done several research projects with MDs and it really depends on the individual, some are some aren't. It depends, but psychologists are… that's what the PhD is for.

 

[Anasazi23]

John, you really have your history wrong! Psychology evolved as a science to attempt to measure what medicine was trying treat as well as many other areas of human cognition and behavior. The field of psychology put the evidence-based idea into psychiatry before there were drug reps around to tell you what that phrase means.

Look it up...

The first randomized controlled medical studies weren't really published until the 1940's, and not by psychologists. Hindsight is 20/20. If the nature of psychology's discipline is to measure, then fine. But to use that to stake claim as the basis of practicing superior medicine, and to assert, as many have on this forum, that psychiatrists don't know what they're doing, is false.

The comment regarding drug reps is interesting. In perusing the psychology forums, there are very frequent jabs at physicians, being insensitive, having "fragile egos," etc, etc. You are presumably psychologically minded. Do you ever wonder if such an huge entire group of people really just suck that bad (physicians, to you), and that psychologists as a huge group are so much more enlightened?

Perhaps it is the nature (and differences) of the work.

Can it be that every physician (the term 'every' is used metaphorically) is ignorant in the ways of evidence based medicine, and that they receive their only continuing pharmacological training through pharmaceutical representatives? Clearly, considering that I personally don't know a physician that doesn't regularly read any journals, doesn't attend conferences, and has somehow thwarted their requirement at completing continuing educational credits, this cannot be the case.

Statements like, "Olanzapine makes you fat, and therefore, should not be used" fail to take into consideration a number of aspects. I, for one, would rather gain 10 lbs than be floridly psychotic, lose my job, and become homeless. Would you? Psychiatrists' "evil medications" have also all but cured new onset catatonic schizophrenia. These cannot be accidents.

Psychiatry has taken heat for being less evidenced based. One can make an argument against this as well. Published studies examining the differences between lithium and placebo date back to 1955 (look it up). But by the nature of the medical specialty, psychiatry is sure to have a lag in the development of certain evidence-based outcome measures. The ideal medical profession in evidence based medicine is that of infectious disease. Organisms are isolated, and through systematic review, medications are found that most effectively bring about bacteriostatic or bacteriocidal results. These medications are further developed to work pharmacodynamically and pharmacokinetically in the human body, and a physician is needed to assess the requirements of said medications in consideration of the patients' concomitant medical diseases. Assuredly, psychiatrists do this as well, both in hospitals, and in their offices. (Do you think a prescribing psychologist would as well, when given the opportunity?)

Psychiatry, indeed most other medical professions, do not have a luxury such as this. Neither psychiatry, nor psychology has discovered all the complexities of the human brain, though they continually try. The natural outcome of this is to use experimentation and pass down, akin almost to a verbal historian, what HAS worked in their scenarios. Psychologists do not want to hear this because it is knowledge that they will really not gain, since they complete no medical or psychiatric residency. (I scoff at the 100 patient requirement - it's a joke). This still occurs in psychiatric residency. These residents incorporate this handed-down information into their studies of EBM, their knowledge of pharmacology, neuroscience, and very importantly, their general medical training, to help best treat patients.

The evolution and subsequent discontinuation of medications is important to keep track of. It makes you a more rounded physician. I don't care how many lunches, pens, clocks, or gift certificates the Abilify reps give our inpatient psych docs. They will never be convinced that it will break a true florid psychosis or true manic episode. Yet, the aripiprazole folks continually come with their data and pamphlets. They've made their own decisions, because they run their own clinical trials continually. If you think psychiatry is the only medical specialy doing the same, I assure you it's not.

Do drug reps bring gifts and lunch? Yes. Do they hand out pamphlets on how Geodon has a prolonged Qtc? Yes. To be ignorant of the marketing strategies used by pharmaceutical companies, and pretend that you can remain blind and objective to these matters is actually doing yourself a disservice. Patients see ads. Physicians see ads. Physicians are marketed to directly and have been for years. It is the physician's responsibility to look up these matters and make their own informed decisions, as I did regarding Geodon's prolonged Qtc interval. (It's not a big deal, and was in my opinion an opposing marketing strategy, though I still practice defensive medicine just in case). This is my job as a physician.

 

[Anasazi23]

Nice quote, but I never said that. It's true that the context of what I said implied that, but I subsequently clarified that. Further, when I mentioned olanzapine, I was thinking of its use in bipolar disorder, not as an acute psychotic treatment.

Good dialogue here...just for the record.

Anywho...I'll clarify myself
I'd rather gain 10lbs than become floridly manic, take a trip to Ireland, blow all my money, have an affair, lose my fiancee, get an STD, and lose my residency placement. Would you?

Yes, I think psychologists would do this if given the opportunity. However, I don't think they would be as good at dealing with complex medication and peripheral disease interactions. In other words, the psychologist would be aware that the situation needs to be considered, but would lack expertise. That said, if sticking to SSRIs and other "limited formulary medications" this might not be a cataclysmic issue. I think most psychologists would know better than nurse practitioners, and, possibly, general practitioners in some ways.

It's good that you think this. There is a saying, however: "You don't know what you don't know." This isn't a putdown, just bringing out the fact that at least a GP would know about disease states and conditions that present themselves. I diagnosed a likely Behcet's syndrome today based on a passing comment by a psych patient that they felt jittery and had a mouth ulcer. Not tooting my own horn, just saying that without studying for medical boards, taking endless classes, I wouldn't have known about this. You might say, "well, that's not psychiatry or psychology...who cares. It's just a lower standard of care for the patient, that's all."

By the way, for the record, psychologists are not fighting for unlimited formulary, INCLUDING complete use of narcotics, heart medications, antibiotics, etc. How do you justify this?

I'm not sure I understand your point here. I completed a residency in a psychiatry department, which included didactics like weekly rounds of varying types, lectures, neuropathology (brain cuttings), etc. . . I am currently considered a "medical resident" by the neurology department I work in. I go to rounds, lectures, colloquia, neuroanatomy courses, etc. .. In addition to the interaction with the M.D.s, I interact with the psychology faculty who are able to pass down their own wisdom. I go to medical conferences and psychology conferences. I publish in medical journals and psychology journals. Where is this big vat of knowledge that I'm not getting that your average psychiatrist with zero interest in research is?

No offense, but you didn't complete a "residency" in anything. You completed a psych internship and maybe a post-doc. First year medical or psych residents aren't even called residents in many institutions. You're not really a medical resident in the neuro dept. either. You're not on call, you're not giving tpa in the ER at 4am, you're not writing scripts all day long, not pushing gad, not praying that the midnight call for non-formulary change won't kill your patient, not getting called for afib on the neuro ward.....know what I mean? It's a very different stress level and assumption of knowledge. Not better or worse, just different. Rounds, lectures, colloquia, neuroanatomy courses, medical conferences and psychology conferences, etc, are all academic endeavors, not clinical duties where you must put years of medical training to good (and better be correct) use.

By the way, there's a lot of research by psychiatrists out there, many more than you think. Don't be so quick to assume. The majority of our psych residents have multiple publications as well.

It seems that many psychology folks call their internships "residency," implying that it's the same thing, and feel that they are junior psychiatrists, since their program is in the psychiatry dept. I really don't mean to be rude, but there are art therapists in the psychiatry dept., and they're not considered medical doctors or residents either. They're completely differnent, and very needed services.

 

[50960]

I have an MD friend who once told me that the buzz with physicians is that psychiatrists are MDs who couldn't get into any other residency. I do not think this is true or valid, and I happen to have alot of respect for psychiatrists I have worked with. However in a way these responses are very similar to the short man getting a big truck.....

 

[Anasazi23]

I have an MD friend who once told me that the buzz with physicians is that psychiatrists are MDs who couldn't get into any other residency. I do not think this is true or valid, and I happen to have alot of respect for psychiatrists I have worked with. However in a way these responses are very similar to the short man getting a big truck.....

Every medical specialty busts on other medical specialties. There was an entire thread on this at one point in (I think) the general residency forums.
Believe it or not, most people I've met are in psychiatry because they like it. It is the most "switched into" residency from other residencies and by other specialty physicians. The entire nature of the match doesn't really make this notion sensible. What, someone puts their first 20 choices as IM and surg, then psych 21? Doesn't make sense. In reality, psych is about as easy to obtain as neuro, IM, GP, pediatrics, etc. If your image is to be a more "medical" medical doctor, anyone can get an IM spot. The "buzz" with psychiatry residents are that they are the folks that had a hard time deciding between surgery and psych, and ultimately decided on psych for the lifestyle. Not so ironically, this was the case with me. (also seriously considered neuro and derm)

Not that you care, and as an interesting aside, in Russia only the students with the highest grades and those deemed to be the brightest and most talented go into psychiatry, and even then, you really need to know someone to get into it. It's deemed as a privilage to study, and the training is quite different. A couple of the Russian attendings were explaining this to us.

 

[Anasazi23]

...Except, I am trained as a scientist first. That is the lens through which I view clinical work. In that this is the case, I think that I am able to swim deeper in the pool than someone only focused on clinical issues that has had to waste time in areas of marginal significance.

Then this is back where we started. It is the understanding that medical doctors are just that...physicians that specialize in the field of psychiatry, while psychologists are scientists that view cases that particular lense.

Oh, and it's funny you mention Behcet's syndrome. I haven't taken any medical boards (I will have to do my own neuropsych board), nor have any of the neuropsych faculty, interns, externs, or graduate students that I work with. Yet just the other day, we concluded that the patient we saw likely had Behcet's.

This is difficult to believe as the wording stands. Where would this have been covered in the average psychology graduate curriculum?

It was, again, not an attempt to show my clinical prowess...the disease is not particularly rare, and is not difficult to diagnose, and is seen by every IM resident and attending. It was to illustrate a point that the literal 1000+ diseases that medical students are forced to memorize serve a purpose, to know that if something looks at least familiar, or you recognize a triad of symptoms that at least jog your memory, you know where to look back and address. How deep should we go in obscure diseases and how often psychologists can diagnose them?

You are correct that the expectations of knowledge are far different between a general M.D. and a general Ph.D. Also, the expectations of knowledge are far different between specialties within both degrees. Is there more stress in M.D. land? Probably, your job kinda sucks really. So what though. I am not an art therapist. I like that though, a not so subtle lumping you've managed there. We have social workers in my department too. They don't try to tease apart progressive supranuclear palsy, corticobasal degeneration, and parkinson's.

Of course, I wasn't implying that you were an art therapist. It was an overdone example of semantic labeling of staff and their department affiliations. I know neuropsychologists that literally have learning disabilities in math, and wouldn't know a post-hoc test if it slapped them in the face. Indeed as you imply, not all training is the same - be it PhDs or MDs.

As far as the 'wasting time with marginally related stuff' concept. I really can understand how you can think this. I said the same things to myself when I was in psych grad school. But, I think it would behoove you to sit through good psychiatry rounds, if you haven't already. You will be surprised at how the complexities of liver function, infectious disease, cardiac function, neruologic, kidney function, and especially endocrinology pathologies interact with psychiatric patients. I am constantly reading about these concomitant conditions, and remain in a slightly nervous state about my knowledge base in these medical disciplines. I know my psychiatry residency colleagues feel the same. It's not for the lack of reading, it the massive amount of medical information which is constantly evolving. It sounds like the psychiatry dept you worked in was sub-par. If you agree that's the case, I definately wouldn't base my entire view of psychiatry on it. Don't discount a seasoned psychiatrist's ability to quickly diagnose and come up with effective treatment plans for bipolar patients, schizophrenics, personality disorders, and every other psychiatric spectrum disorder. Pencil and paper tests cannot use the inert flexibility of psychiatric interview training, combined with observation. These, along with newer techniques on the horizon (transcranial magnetic stim, vagus nerve stimulation, etc) are exciting areas for psychiatry. Further, there are subtleties that clinicians develop when doing this day and night for years. I still see it with many psych attendings. It's actuall quite impressive to see unfold. Perhaps you've seen it in your psychiatry rotation.

 

[PsychMD]

I am constantly reading about these concomitant conditions, and remain in a slightly nervous state about my knowledge base in these medical disciplines.

I have been in post-residency practice for quite a while, primarily in acute inpatient work and consultation-liaison psychiatry.

This is a quite accurate description of the life-long condition of any psychiatrist. I say this, not with false modesty nor with fake pomposity, but with sincere humility and awe towards the responsibility carried by any practitioner who abides by the law and oath of "primum non nocere", by education, by formation, by training, and by practice. In spite of daily whining about lifestyles and salaries, in spite of turf battles, this is the crux of or daily and life-long labor, and this is why we all identify first as physicians, and then as specialists.

 

[skpsycho]

<...> in Russia only the students with the highest grades and those deemed to be the brightest and most talented go into psychiatry, and even then, you really need to know someone to get into it. It's deemed as a privilage to study, and the training is quite different. A couple of the Russian attendings were explaining this to us.

They are liars! This is ridiculous. It might have been so fifty years ago in Soviet Union, but certainly not within last 20 years or so. Nobody wants to go into psychiatry in Russia, except for those who really dig it (for some strange reason, because the field is a disaster, a la the ****oo's nest). It is not competitive at all. Maybe there is some competition in forensics, but to work in Russian legal system one needs to be a special kind of person.

------------
skpsycho (http://skpycho.wordpress.com/)

 

[Anasazi23]

They are liars! This is ridiculous. It might have been so fifty years ago in Soviet Union, but certainly not within last 20 years or so. Nobody wants to go into psychiatry in Russia, except for those who really dig it (for some strange reason, because the field is a disaster, a la the ****oo's nest). It is not competitive at all. Maybe there is some competition in forensics, but to work in Russian legal system one needs to be a special kind of person.

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skpsycho (http://skpycho.wordpress.com/)

Well, they were older attendings...so perhaps.

Why such the 2d10 axe to grind with psychiatry, btw?

 

[skpsycho]

Why such the 2d10 axe to grind with psychiatry, btw?

Excuse me?

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skpsycho (http://skpsycho.wordpress.com/)